Pharmaceutical Needs Assessment January 2011

Transcription

1 January 2011 Annual Review by January 2012 Comprehensive review and consultation by January 2014 Issue 1: January

2 CONTENTS GLOSSARY OF ABBREVIATIONS..3 EXECUTIVE SUMMARY.5 INTRODUCTION...8 POLICY CONTEXT...9 REGULATORY REQUIREMENTS FOR PNAs PNA DEVELOPMENT AND CONSULTATION PLAN.14 PRIORITIES FOR IMPROVING HEALTH AND WELLBEING...16 Mapping community pharmacy contribution to NHS Wirral priorities...19 CURRENT PROVISION OF SERVICES 25 Benchmarking provision of NHS Wirral pharmacy services.26 Locality provision within NHS Wirral...30 Essential Services.40 Advanced Services...42 Enhanced Services...46 Patient Experience 57 CONCLUSIONS AND RECOMMENDATIONS FOR THE FUTURE..60 APPENDIX 1 PNA Development core team APPENDIX 2 Consultation plan..64 APPENDIX 3 Location of pharmacies and allocation to localities and wards...66 APPENDIX 4 Opening hours of pharmacies...70 APPENDIX 5 Table of service providers APPENDIX 6 Maps of services 81 APPENDIX 7 Community pharmacy patient questionnaire report APPENDIX 8 Guidance and further reading APPENDIX 9 NHS Wirral Strategic Plan Issue 1: January

3 GLOSSARY OF ABBREVIATIONS AAACM ADHD ARCH AUR BME BMI BWW CAMHS ccbt CEO CHD COPD CPPQ CVD EHC EoLC EPS FOI GMS GUM HIV HPV HSIS ICaH IMD IOG JSNA LD LE LES LINKs LMC LPC LPS LSOA LTC LWMS MAS MDS MUR NCMP All Age, All Cause Mortality Attention Deficit Hyperactivity Disorder Advice, Rehabilitation, Counselling and Health Appliance Use Review Black and Minority Ethnicities Body Mass Index Bebington & West Wirral Child and Adolescent Mental Health Service Computerised Cognitive Behavioural Therapy Service Chief Executive Office Coronary Heart Disease Chronic Obstructive Pulmonary Disease Community Pharmacy Patient Questionnaire Cardio Vascular Disease Emergency Hormonal Contraception End of Life Care Electronic Prescription Service Freedom of Information General Medical Services Genito-urinary Medicine Human Immunodeficiency Virus Human Papilloma Virus Health Services in Schools Integrated Care at Home Index of Multiple Deprivation Improving Outcome Guidance Joint Strategic Needs Assessment Learning Disabilities Life Expectancy Local Enhanced Service Local Involvement Networks Local Medical Committee Local Pharmaceutical Committee Local Pharmaceutical Services Lower Super Output Area Long Term Condition Lifestyle & Weight Management Service Minor Ailment Service Monitoring Dosage System Medicines Use Review National Child Measurement Programme Issue 1: January

4 NW ONS PBC PCAU PCT PGD PMR PNA PPD PSNC RD SAC SCP SHA SLA STI TIA TOP VCAW VRA WBC WCC WCPCT WMO WMS WW4H Northwest Office of National Statistics Practice Based Commissioning Primary Care Assessment Unit Primary Care Trust Patient Group Direction Patient Medication Record Prescription Pricing Division Pharmaceutical Services Negotiating Committee Repeat Dispensing Stoma Appliance Customisation Strategic Commissioning Plan Strategic Health Authority Service Level Agreement Sexually Transmitted Infection Transient Ischaemic Attack Termination of Pregnancy Voluntary and Community Action Wirral Vascular Risk Assessment Wirral Borough Council World Class Commissioning Western Cheshire Primary Care Trust Wirral Multicultural Organisation Weight Management Service Wirral Working 4 Health Issue 1: January

5 EXECUTIVE SUMMARY Key Findings This assessment has found that the population of Wirral has better access to pharmacy services than in our peer group and that there is capacity in the pharmacy network to absorb increases in activity from the expected growth in the population over the next five years. Our existing network provides a comprehensive essential pharmaceutical service to our population. When compared with PCTs within our peer group the provision in Wirral is better in terms of the number of pharmacies per head of population and workload indicators. The widespread availability of premises with consultation facilities in Wirral means that our population has good access to high quality premises. There is good access to pharmacy services throughout the week, into the evening and at weekends across Wirral. NHS Wirral relies on the extended hours provision by the 100 hour contracts. In addition, these extended hours contracts have negated the need for the PCT to resource evening and weekend rotas. Any change to these opening hours will have a detrimental effect on access and service provision. There is generally good provision of advanced and enhanced services across our population, we will continue to work with our existing contractors to ensure that this provision matches the needs of our population and that any inequalities in activity are minimised. Patients and public who have been consulted did not identify any specific gaps in provision which would require the commissioning of any new pharmacy contracts, patients felt that they had a good choice of pharmacy service providers. The PCT is not aware of any patients or members of the public that have submitted complaints regarding inadequate access to services. In summary, there is no identified need for pharmaceutical services which would be met by commissioning additional pharmacy contracts. The period of growth in commissioning enhanced services in line with local health needs now needs to be matched by a period of consolidation which is focused on ensuring that there is good access and consistent provision across the population for both enhanced and advanced services from existing contractors. Issue 1: January

6 Consolidating Community Pharmacy Provision The review of pharmacy services has identified actions to optimise the potential of the pharmacy contract for our population. Embed and optimise essential services, specifically: to support contractors to make more interventions in public health and health promotion; to prepare the organisation for the implementation of the Electronic Prescription Service Release 2 so that patients, pharmacists and GPs can quickly realise the benefits of electronic prescribing. Focus on advanced services, specifically: Build on our success in the provision of advanced services by focusing on inequalities in provision to our population; Support active providers to increase their provision of advanced services by conducting more reviews; Support accredited providers that are not active to begin to deliver reviews Expand current work, linked to the PCT s referral for medication review service, to ensure MURs are well targeted to the patients most in need of support. Consolidate enhanced services commissioning: We will audit at a locality level to identify areas where activity is not aligned with commissioning intentions; We will identify pharmacies that are successfully delivering multiple enhanced services and work with them to share best practice with other providers; The plans for improvement will depend on whether the service is accessed by patients depending on their choice of provider, or pharmacies are relied upon to proactively invite patients, e.g. for the alcohol screening service. Directed Enhanced Services Applicants using one of the four exemptions to the control of entry test under the current legislation should be required to provide all of the following enhanced services: o Smoking cessation service o Weight management service for referred clients o Emergency hormonal contraception + service o Alcohol screening service o Sharps service (for insulin and other self-injected medication) Issue 1: January

7 In addition, applicants will be required to provide the following services if required by the PCT:- o Holding stocks of palliative care drugs if further providers are required, dependant on the spread of existing providers at the time o Services for drug misuse clients (supervised consumption and needle exchange) if clients choose to access services from those premises All applicants should therefore be prepared to offer these services and any future services that are commissioned in line with identified health needs. Issue 1: January

8 INTRODUCTION What is a? A pharmaceutical needs assessment forms part of the commissioning function of a Primary Care Trust (PCT). This assessment describes current community pharmacy services and sets this provision in the context of population characteristics and priorities for improving health and well being and reducing health inequalities in Wirral. Commissioning functions for community pharmacy services can be divided into three elements: 1. Managing the nationally commissioned aspects of the pharmacy contract, particularly ensuring that standards are maintained and the contract is fully utilised so that the benefits of the essential and advanced services are widely available. 2. Determining which local enhanced services should be commissioned and where they are most likely to be required in line with health needs. 3. Decision making by the PCT Pharmacy Contracts Committee to: 3.1. Determine if a new contract is required in response to applications to provide services Determine, in certain types of application, whether the provider should be required to provide certain enhanced services as a condition of granting the application Determine whether an application for a change in the location or type of pharmacy services should be approved. The PNA provides a good understanding of the needs of our population and the potential for all providers to develop and deliver the pharmaceutical services that the PCT needs. However, the PNA is not a stand-alone document and should be considered alongside other strategic and planning documents, including the Joint Strategic Needs Assessment (JSNA) and the Strategic Commissioning Plan (SCP). The PNA is also an opportunity to inform the development of any future pharmacy commissioning strategies, which is an integral part of the PCT s planning process to secure the provision of pharmacy services that our population needs. Issue 1: January

9 POLICY CONTEXT A Vision for Pharmacy in the New NHS In the last five years, the pace of change for NHS community pharmaceutical services has probably been more rapid than at any other time in the last 60 years. In that same period, community pharmacy has featured more prominently in how to improve services, how its potential can be more widely recognised by the NHS and by other health professionals, and how its ability to respond innovatively and creatively can be better utilised. That is what was intended when the Department of Health launched A Vision for Pharmacy in the New NHS in July 2003, that identified and aligned the ambitions for pharmacy alongside the wider ambitions for the NHS as a whole. The current policy context shaping the direction of pharmacy services has its roots in the publication of Choosing Health published by the Government in This programme of action aimed to provide more of the opportunities, support and information people want to enable them to improve their health. Choosing Health Through Pharmacy As part of the Choosing Health programme, the Government made a commitment to publish a strategy for pharmaceutical public health which expanded the contribution that pharmacists, their staff and the premises in which they work can make to improving health and reducing health inequalities. This strategy recognised that pharmacists work at the heart of the communities they serve and they enjoy the confidence of the public. Every day, they support self care and provide health messages, advice and services in areas such as diet, physical activity, stop smoking and sexual health. A New Contractual Framework As part of the Vision for Pharmacy a new community pharmacy contractual framework was put in place in April It comprises three tiers of services essential, advanced and local enhanced services. Essential services are those which every pharmacy must provide, including dispensing. Advanced services are those which, subject to accreditation requirements, a pharmacy contractor can choose to provide. At present, there are three advanced services, Medicines Use Reviews (MUR), Appliance Use Reviews (AURs) and Stoma Appliance Customisation (SAC). In MURs and AURs the pharmacist discusses with the patient their use of the medicines or appliances they are prescribed and whether there are any problems that the pharmacist can help resolve. For SAC the aim is to ensure proper use and comfortable fitting of the stoma appliance and to improve duration of usage thereby reducing waste. Issue 1: January

10 Local enhanced services, such as health and lifestyle advice or help for substance misusers, are commissioned locally by PCTs direct with contractors. Community pharmacies are remunerated through this national contractual framework, the majority of the income to community pharmacy is made through fees, allowances and retained purchasing profit which is controlled at a national level to provide an agreed return on investment to pharmacy contractors. In return pharmacy contractors must provide certain specified services at agreed times. Around 85% of community pharmacy income nationally comes from NHS services. A growing source of income to community pharmacies comes from providing enhanced services commissioned by PCTs. Pharmacies provide both NHS funded care and services that are paid for directly by the patient. Some community pharmacies provide these non-nhs services to our population. These include: Over the counter medication, including supply of emergency hormonal contraception and smoking cessation Measurements like blood pressure, weight and height Diagnostic tests like cholesterol and blood glucose Our health, our care, our say This White Paper in January 2006 set out a new strategic direction for improving the health and well-being of the population. It focused on a strategic shift to locate more services in local communities closer to people s homes. This recognised the vital role that community pharmacies provide in providing services which support patients with long term conditions and make treatment for minor illnesses accessible and convenient. NHS Next Stage Review The final report set out a vision of an NHS that gives patients and the public more information and choice, works in partnership and has quality of care at its heart quality defined as clinically effective, personal and safe. The changes that are now being taken forward, locally and nationally, will see the NHS deliver high quality care for all users of services in all aspects, not just some. It will see services delivered closer to home, a much greater focus on helping people stay healthy and a stronger emphasis on the NHS working with local partners. Pharmacy has a key role to play in delivering this vision, particularly as a provider of services which prevent ill-health, promote better health for all and improve access to services within communities. Pharmacy in England - Building on strengths delivering the future In April 2008 the government set out its plans in this Pharmacy White Paper and subsequently a consultation was undertaken on the proposed changes to the regulations for pharmacy. This White Paper sets out a vision for improved quality and effectiveness of pharmaceutical services, and a wider contribution to public health. Whilst acknowledging good overall provision and much good practice amongst providers, it revealed several areas of real concern about medicines usage across the country which it seeks to address through a work programme which will challenge and engage PCTs, pharmacists and the NHS. Issue 1: January

11 It identifies practical, achievable ways in which pharmacists and their teams can improve patient care in the coming years. It sets out a reinvigorated vision of pharmacy s potential to contribute further to a fair, personalised, safe and effective NHS. This vision demonstrates how pharmacy can continue, and expand further, its role in an NHS that focuses as much on prevention as it does on treating sick people, helping to reduce health inequalities, supporting healthy choices, improving quality and promoting well-being for patients and public alike. This White Paper has put forward a broad range of proposals to build on progress over the last three years which has succeeded in embedding community pharmacy s role in improving health and well-being and reducing health inequalities. An overview is set out below in Figure 1. This includes proposals for nationally commissioned additions to the contract in future years for how pharmacies will, over time: offer NHS funded treatment for many minor ailments (e.g. coughs, colds, stomach problems) for people who do not need to go to their local GP; provide specific support for people who are starting out on a new course of treatment for long term conditions such as high blood pressure or high cholesterol; be commissioned based on the range and quality of services they deliver. Figure 1: Pharmacy White Paper - Summary Building on strengths delivering the future The Aims of the White Paper, Pharmacy in England Supporting healthy living and better care Community pharmacies will become healthy living centres providing a primary source of information for healthy living and health improvement. Pharmacy will be integrated into public health initiatives such as stop smoking, sexual health services and weight management, or offer screening for those at risk of vascular disease an area where there are significant variations in access to services and life expectancy around the country. Access and choice Community pharmacies improve access and choice through more help with medicines. This will be realised by developing MURs, repeat dispensing, access to urgent medicines, emergency supply and working with hospitals on medicine reconciliation. Better, safe use of medicines Safe medication practices should be embedded in patient care by identifying, introducing and evaluating systems designed to reduce unintended hospital admissions related to medicines use. Identifying specific patient groups for MURs, using MURs and repeat dispensing to identify and reduce the amount of unused medicines and including pharmacists in care pathways for longterm conditions are all examples of this. Integration and interfaces Community based pharmaceutical care will be developed which will involve creating new alliances between hospital and community pharmacists as well as primary care pharmacists and pharmacy technicians. Quality Underpinning all of this in the White Paper and the other policy drivers mentioned earlier is continual improvement in quality. This is a recurring theme throughout all the policy drivers currently influencing the development of community pharmacy. This refers to staff, premises and services alike. PCTs have a responsibility to ensure continuous quality by monitoring the community pharmacy services against the strategic tests. Issue 1: January

12 REGULATORY REQUIREMENTS FOR PNAs NHS Wirral PNAs were first developed in 2005 to assist PCTs in preparing for changes to market entry but they were not a requirement for decision making. The White Paper Pharmacy in England: Building on strengths delivering the future highlighted variation in the structure and data requirements of PNAs and confirmed that they required further review and strengthening to ensure they provided an effective and robust commissioning tool which supports PCT decisions. A consultation was held in 2008 on proposals for legislative change in order to provide PCT s with more flexibility when commissioning pharmaceutical services and in managing the performance of providers. The Health Act 2009 amended the National Health Service Act 2006 to include provisions for regulations to set out the minimum standards for PNAs. The regulations came into force on 24 May 2010 and require PCTs to develop and publish PNAs; and then to use PNAs as the basis for determining market entry to NHS pharmaceutical services provision; also introduce new quality requirements for pharmaceutical contractors. It is anticipated that further legislation will be put in place in 2011 to govern PNAs being used to determine applications to provide pharmaceutical services, in response to the 2008 consultation to allow increased local flexibility. Publication and review timeframes for PNAs The regulations place a statutory duty on each PCT to develop and publish their first PNA by 1 February The regulations set out the minimum requirements for the first PNA produced under the regulations, such as data on the health needs of the PCT s population, current provision of pharmaceutical services, gaps in current provision and how the PCT proposes to close these gaps. The PNA should also consider the future needs for services. The regulations require PCTs to undertake a consultation on their first PNA for a minimum of sixty days, and list those persons and organisations that must be consulted e.g. the Local Pharmaceutical Committee, Local Medical Committee, LINKs and other patient and public groups. The regulations also require the PCT to define localities around which the PNA will be structured so that the comparative needs of different populations can be taken into account. Circumstances under which the PNA is to be revised or updated It is important that the PNA reflects changes that affect the need for pharmaceutical services in Wirral. Where the PCT becomes aware that a change may require the PNA to be updated then a decision to revise the PNA will be made by the Pharmacy Contracts Committee. There are two mechanisms by which the PNA may be updated: Where there has been a change which has not affected the need for pharmaceutical services then the PCT will issue a supplementary statement describing the change Issue 1: January

13 Where there has been a change which has affected the need for pharmaceutical services then the PCT will update the PNA and consult with stakeholders on the revised PNA An annual review will be conducted to ensure that any changes that have taken place are reflected in the PNA or its supplementary statements. The PNA must be reviewed in full every three years with further consultation periods. Issue 1: January

14 PNA DEVELOPMENT AND CONSULTATION PLAN NHS Wirral s PNA was developed using a number of methods that draw on a range of information sources and the outcome is reinforced by patient experience analysis. The process was divided into five steps which are illustrated by Figure 2, below. Figure 2: NHS Wirral PNA development process Step 1 Step 2 Step 3 Step 4 Step 5 PNA development process Step 1: PCT priorities, health needs Step 2: Pharmacy profile and audit Step 3: Patient experience Step 4: Synthesis and assessment Step 5: Consultation and consensus Pharmaceutical Needs Assessment Pharmacy commissioning strategy The development process combines the PCT s strategic plans, draws on the JSNA which describe the health needs of our population and links this to the commissioning of pharmacy services. The PNA provides a foundation for further work to consolidate the pharmacy commissioning strategy for the PCT. Each step has a specific function and / or source of data which is described in Figure 3, below. Figure 3: NHS Wirral PNA development data sources and activity Step Data source(s) Activity PCT Strategic Plan Analysis and synthesis of relevant data to Step 1 JSNA 2009 link to the PNA. Step 2 Step 3 Step 4 Step 5 Routine contracting and activity data which is held by the PCT National benchmarking using NHS Information Centre data Community Pharmacy Patient Questionnaire (CPPQ) returns Small-scale semi structured interviews with Wirral residents Summer 2009 Regulations published to inform PCTs of their consultation requirements in relation to PNAs Validation via a survey of community pharmacy contractors in July 2010 Analysis of CPPQ returns September 2010 Drawing together and synthesis of emerging themes and ideas Drafting the PNA and synthesis of the assessment and recommendations Issue 1: January

15 These data have been combined to provide a picture of our population, their current and future health needs and how our pharmacy network can be used to support the PCT to improve the health and wellbeing of our population. A number of PCT staff were involved in the development of this PNA from the following Directorates, Public Health; Finance; Communications and Engagement; Primary Care and Provider Services, in addition to the process being led by the Medicines Management Team. Consideration was given to conflicts of interest and this information is included in Appendix 1. Consultation plan and PCT approval The PCT is required to undertake a consultation on the PNA for a minimum of sixty days, and the regulations list the minimum standard for those persons and organisations that must be consulted. The Professional Executive Committee, with delegated responsibility from the PCT Board, was responsible for agreeing the consultation plan in Appendix 2. The process provided assurance that hard copies were received by requiring a signature upon delivery. ed copies requested the consultee confirmed receipt and plans were made to follow up non-responders. Feedback from the consultation and amendments made as a result will be approved by the Professional Executive Committee in January The final PNA will be published by February 1 st Issue 1: January

16 PRIORITIES FOR IMPROVING HEALTH AND WELLBEING The Strategic Plan sets out our plans and priorities for reducing health inequalities and improving life expectancy in Wirral. Through working with our partners we have developed a vision around which we are united. The latest Strategic Plan ( ) available at: The Joint Strategic Needs Assessment (JSNA) informs all PCT commissioning plans. Public health data to support the PNA has been drawn from the local JSNA from January 2009, which is available by following the link: Our Vision : NHS Wirral Working Together for a Healthier Future To achieve this vision, NHS Wirral has four strategic aspirations to: involve and empower people target inequalities through effective partnerships ensure excellence in our health services be a high performance, high reputation organisation To deliver this vision we will work to address each of our key health needs to: have a frontline workforce that delivers health improvement Work with partners to reduce the numbers of people who do not work prevent falls in the elderly target alcohol misuse, with prevention and treatment improve the mortality rate for breast cancer screen all smokers in the future for evidence of poor respiratory function identify and treat more cardiovascular disease improve mental health tackle obesity of families and their children work to reduce unwanted pregnancies stop more people smoking We have identified outcomes for each of our health needs, against which our investments will be prioritised: Smoking (smoking quitters) Alcohol (rate of hospital admissions per 100,000 for alcohol related harm) Obesity (obesity at reception years) Sexual health (under 18 conception rate) Mental health (hospital admissions caused by unintended and deliberate harm) Cancer (breast cancer mortality) COPD (uptake on pneumococcus vaccinations by over 65's) CVD (percentage of stroke admissions given a brain scan within 24 hours) Issue 1: January

17 Other PCT priorities which will influence our plans include: Children s services Elderly care Urgent care Our ambition NHS Wirral Our ambition for Wirral is to improve health for all our residents and first and foremost to reduce health inequalities. The Strategic Plan for Wirral ( ) concentrates on the management of long-term medical conditions and the promotion of healthy choices. With programmes focused on improvements in the main causes of mortality and unhealthy lifestyles in Wirral - alcohol, cancer, cardiopulmonary disease, cardiovascular disease, mental health, obesity, smoking, and sexual health. Through these programmes and investments we will reduce health inequalities and improve life expectancy. We will address the needs of an increasingly ageing population and we will work with partners to ensure that we respond to the needs of vulnerable children and young people. We cannot deliver this ambition without working with all healthcare providers, including our community pharmacies. To succeed we will need to harness the full potential within our pharmacy provider network and to bring to bear the unique qualities and focus of community pharmacy on our health challenges. Community pharmacy potential There is a good fit between our priorities, which are described above, and the potential contribution of community pharmacy. Community pharmacy services need to be planned within a framework which links our pharmacy commissioning with strategic plans for health in Wirral and that are focused on our local priorities for reducing inequalities in health outcomes. Mapping how pharmacy contributes today, and can contribute in the future will help to focus and prioritise our efforts and provide a basis for making rational decisions about our future commissioning plans. Commissioning decisions are made with the objective of ensuring that the investment we make represents the best use of resources, provides value for money, has quality and safety embedded and takes us closer to achieving the outcomes we have prioritised. As a high performing commissioner we recognise that we need to develop and nurture local markets to ensure that we can offer our population a choice of high quality providers. This is important in managing and engaging with the pharmacy market, this PNA is our first opportunity to do this in a structured way. We have a track record for investing in pharmacy interventions over the years and we are committed to continuing to invest in value for money services from all providers in pursuit of our vision. Issue 1: January

18 Development of enhanced pharmaceutical services NHS Wirral The development of community pharmacy enhanced services, across the country has often been opportunistic and unplanned. A service development may emerge as the result of a coming together of circumstances and funding to provide an opportunity to develop services. Consequently services are often developed rapidly, and without the opportunity to locate these services within a coherent pharmacy strategy. NHS Wirral has been active in commissioning enhanced services and has demonstrated that it is possible to commission a range of services in line with identified health need. Currently the PCT behaves as both commissioner and facilitator for new services development. For example the PCT negotiates the fee structure, provides training, develops protocols and documentation and accredits service providers. This is an important transitional role necessary to encourage the provider network to mature, to safeguard quality and to ensure plurality of providers within primary care. Good practice commissioning principles require that the ongoing commissioning of pharmacy services is actively managed in order to ensure that the service meets a need and that the number of providers and the levels of activity remain at a level that meets the needs of the population. Synthesis To map community pharmacy s current and potential contribution we have developed a framework which links the community pharmacy contractual framework, including both the nationally and locally commissioned elements, to our plans and priorities. For each intersection between the contractual framework and one of our priorities we have identified: What community pharmacy is currently contributing within the existing commissioning envelope, How existing performance or commissioning could be improved to further meet the needs of our population, and Any additional commissioning that should be considered in the future This framework is described on the following pages. Issue 1: January

19 Mapping community pharmacy contribution to NHS Wirral priorities NHS Wirral Goals and initiatives from JSNA and Strategic Plan Essential services a) Current contribution b) Potential contribution with actions Advanced services a) Current contribution b) Potential contribution with actions Enhanced services a) Current contribution b) Potential contribution with actions Future considerations to improve existing provision Alcohol a) The contract includes provision for pharmacies to provide support for locally agreed public health campaigns. Pharmacy contractors are also expected to offer signposting and advice on healthy lifestyles to pharmacy users. b) The PCT may select an alcohol campaign as one of the six public health campaigns each year. a) Nil a) NHS Wirral commissions an alcohol intervention service from all community pharmacies willing to provide this service in Wirral. Provision is focused in pharmacies in Birkenhead (90%) and to a lesser extent in Wallasey (71%) and Bebington and West Wirral (50%) which follows the pattern of high alcohol consumption observed in our population. b) Encourage the b) Already commissioned. recording of alcohol consumption and inclusion of brief alcohol advice with medicines use review. Commissioning a locally enhanced service for alcohol interventions from community pharmacy is a relatively novel development. In this respect NHS Wirral is recognised as a local and national leader. There is potential to improve provision in low activity providers via continued sharing of good practice and the negotiation of a revised service level agreement with minimum activity requirements. Cancer a) The contract includes provision for pharmacies to provide support for locally agreed public health campaigns. Pharmacy contractors are also expected to offer signposting and advice a) Nil a) NHS Wirral currently commissions weight management, alcohol and smoking services from pharmacy which all have the potential to contribute directly to the reduction in cancer prevalence rates. NHS Wirral s focus on commissioning pharmacies to provide interventions in relation to smoking, alcohol and weight management means that there are already effective interventions focused on cancer prevention. There is the potential to explore community pharmacy s contribution to cancer Issue 1: January

20 COPD on healthy lifestyles to pharmacy users. b) The PCT may select a cancer awareness campaign focused on early detection as one of the six public health campaigns each year. a) See previous description of public health and signposting services. b) The PCT may select a smoking campaign as one of the six public health campaigns each year. NHS Wirral commissions a palliative care medicines access service which ensures that medicines for end of life care are available when required by patients and their carers. b) b) Catch-up HPV immunisation programmes through pharmacy. a) Patients with COPD may be offered a MUR by their community pharmacist. b) MURs targeted at COPD patients a) NHS Wirral currently commissions a smoking service from pharmacy which has the potential to contribute to a reduction in COPD prevalence. b) Community pharmacy COPD management service. NHS Wirral detection through raising awareness among the population. Examples of areas with potential application in the community pharmacy setting from other PCTs include: skin cancer, oral cancers and colon cancers. There is also the potential to consider targeted community pharmacies to manage the uptake of HPV vaccine in any populations where vaccination rates are low (e.g. Westminster PCT) COPD is a progressive disease with a significant pharmacotherapeutic element. Patients with COPD will have an escalating requirement for care which can results in episodic emergency admissions. Interventions using community pharmacy are focused on 1) improving the effectiveness of drug therapy to reduce exacerbations and to minimise unwanted effects. 2) reducing unplanned admissions through monitoring and escalating care within an agreed pathway. There is the potential in NHS Wirral to use the Advanced Services element of the contract to consider commissioning targeted medicines use reviews for this patient group (e.g. Leicester City PCT) and to commission a COPD enhanced service to monitor lower tier patients for signs of exacerbation (e.g. Dorset PCT) Issue 1: January

21 CVD a) See previous description of public health and signposting services. b) The PCT may select a CVD campaign as one of the six public health campaigns each year. a) Patients with CVD may be offered a MUR by their community pharmacist. b) MURs targeted at CVD patients a) NHS Wirral currently commissions smoking and obesity services which have the potential to contribute to a reduction in CVD prevalence. b) NHS vascular risk assessments. NHS Wirral The NHS vascular risk assessment (VRA) programme seeks to screen and assess the population for risk of CVD. There is considerable community pharmacy commissioning activity elsewhere in the country, which is seen as ideally placed to undertake opportunistic interventions. A successful scheme would need to demonstrate that local community pharmacies can approach and recruit the target population. There may be potential to build on the success of the PCT s enhanced services e.g. alcohol screening to develop a local VRA programme in community pharmacy. However at the current time a range of non-pharmaceutical providers are commissioned to deliver the service activity required. Mental Health a) See previous description of public health and signposting services. b) The PCT may select a mental health campaign as one of the six public health campaigns each year. a) Patients taking treatment for mental health conditions may be offered a MUR by their community pharmacist. b) MURs targeted at patients taking treatment for mental health conditions Community pharmacists highlighted CVD risk assessment as a potential role they are enthusiastic to provide if funding becomes available. a) Nil Successfully managing mental health in our population relies upon a network of services from GP through to specialist services provided in the b) Medication adherence monitoring and information exchange. community. There are limited examples of community pharmacy interventions that target less severe mental health problems. However there are examples of how community pharmacists can use their expertise on medicines to support patients in the community and to work with community mental health teams to identify patients at risk of escalation through managing and monitoring adherence to medicines (e.g. Sheffield MIES). Issue 1: January

22 Obesity a) See previous description of public health and signposting services. a) Nil a) NHS Wirral currently commissions a weight management service from 36% of pharmacies. A Weight Management Service (WMS) using a Patient Group Direction (PGD) for anti-obesity drugs could be commissioned. b) The PCT may select a weight management campaign as one of the six public health campaigns each year. b) Nil b) already commissioned A WMS to support patients prescribed anti-obesity drugs by their GP could also be commissioned to improve compliance, treatment outcomes and value from prescribing costs. Community pharmacists highlighted WMS as a potential role they are enthusiastic to provide if funding becomes available. Sexual health a) See previous description of public health and signposting services. b) The PCT may select a sexual health campaign as one of the six public health campaigns each year. a) Nil a) NHS Wirral currently commissions an emergency contraception + supply service from community pharmacy. b) Nil b) Explore the potential to extend the sexual health service that is commissioned to include Chlamydia screening and treatment. Supply of emergency contraception through community pharmacies is one of the first locally commissioned enhanced services. First established in Manchester in December 1999 this service is not commissioned by over 75% of PCTs. Commissioning is developing from an EHC supply service to a dedicated sexual health and contraception service with examples in other PCTs of Chlamydia testing, ongoing contraception advice and support provided (e.g. Manchester PCT) Community pharmacists highlighted Chlamydia testing and treating as a potential role they are enthusiastic to provide if funding becomes available. Smoking a) See previous description of public health and signposting services. a) Nil a) NHS Wirral currently commissions a smoking cessation service from 88% of community The role of community pharmacy in providing an effective stop smoking service is well documented and accepted. Issue 1: January

23 pharmacies. NHS Wirral Elderly Care Access b) The PCT may select a stop smoking campaign as one of the six public health campaigns each year. a) Dispensing and repeat dispensing are important essential services for our elderly population. Many pharmacies offer collection and delivery services for housebound patients which is provided outside the contract requirements. b) Make better use of repeat dispensing to support patients with medicines taking a) The community pharmacy contract recognises that pharmacies are sources of advice and support to patients with self limiting conditions. Although this role is not formalised or subject to any explicit specification. b) Record smoking status and include brief intervention with medicines use review. a) Elderly patients will be a significant population for MUR. The PCT has a Medication Review Referral Service, which triages appropriate referrals to PCT pharmacists for clinical review or to community pharmacy MURs including domiciliary MURs. b) We need to work with contractors to increase the number of pharmacy based and domiciliary MURs following triaged referrals from the PCT service. b) Review service against NHS employers best practice guidance 1. a) A number of enhanced services will be of benefit to elderly patients but there are currently no enhanced services specifically targeted at elderly patients (note advanced services provision). Note that GPs have requirements to undertake medication review as part of their contract. b) There is potential to further develop services to support patients in how they take their medicines to maximise treatment outcomes. a) Nil a) NHS Wirral commissions an emergency contraception + and a palliative care medicines service which both contribute to improved access for patients with specific needs. The most relevant opportunity is to use community pharmacy s expertise on medicines to provide services to support medicines taking. Onward triage to MUR from the PCT s medication review referral service is another novel approach that better maximises nationally contracted services such as MUR, by targeting MURs to patients with a need identified by GPs, community and social care teams referring into the service. Under the national contract pharmacies can self-select patients on multiple medication for MUR and although PCT s can only recommend target groups for MUR, this PCT has been successful in engaging the LPC and contractors to accept triaged referrals for MUR. Pharmacy minor ailment schemes are the fastest growing area of local commissioning by PCTs with commissioning focused in PCTs with higher levels of deprivation and greater health inequalities. In England 56% of PCTs commission a pharmacy MAS with 81% of PCTs in the same ONS cluster as NHS Wirral commissioning this service. The main drivers for 1 Issue 1: January

24 b) Nil b) Nil b) Commission a pharmacy minor illness scheme if access becomes more problematic or if GP Consortia wish to expand their capacity by subcontracting treatment of minor ailments. NHS Wirral pharmacy minor ailments services (MAS) appear to be improvement of the primary care performance regarding access, unscheduled care and encouraging self-care. Access is not considered currently to be an issue in Wirral that would require PCT commissioning of a MAS. The rationale for a pharmacy minor ailment scheme is that the behaviour of patients can be changed such that the community pharmacy is seen as the first port of call for advice and treatment rather than the GP. The schemes achieve this by removing barriers medicines are free to patients that are exempt from prescription charges and pharmacies are more accessible; by changing perceptions pharmacies are promoted as the first port of call for minor illnesses; and by encouraging self care pharmacies can be effective patient educators. Therefore the current PBC clusters/practices or the GP Consortia of the future may wish to consider this opportunity to expand their capacity to enable them to manage patients with more complex health needs in the community. Community pharmacists highlighted MAS as a potential role they are very enthusiastic to provide, as a national service or as a locally commissioned enhanced service, if funding becomes available. Issue 1: January

25 CURRENT PROVISION OF SERVICES This section describes the current provision of pharmaceutical services to the population of NHS Wirral. It provides an account of current provision using a variety of data sources to benchmark our services against external comparators and internally across localities. The data presented here are drawn from: data available through the NHS Information Centre data available to the PCT through the NHS Business Services agency which administers a number of elements of the contract on behalf of the PCT data held by the PCT relating to the commissioning of enhanced services data from a postal survey of our community pharmacy contractors in July 2010, which forms a baseline audit of pharmacy services. (i) Background and setting Wirral is a peninsular area formed by the Dee and Mersey rivers. Wirral covers an area of over 220 sq km with a resident population of 309,000. The resident population is those recorded as living in Wirral from Census data. The population registered with GP practices is 332,000. NHS Wirral has contracts with 86 community pharmacy contractors, 61 GP practices and 50 dental practices. Our communities show marked inequalities in health and life expectancy. This is underpinned by inequalities in social circumstances which characterise our neighbourhoods, with people in Royden expected to live 11 years longer than people in Tranmere. The PCT is grouped with fifteen other PCTs with similar characteristics by the Office of National Statistics (ONS). This group is described by the ONS as the Industrial Hinterlands cluster group. More information about clusters and their construction can be found here: mmaries.asp) Industrial Hinterlands PCTs: County Durham Darlington Gateshead Halton and St Helens Hartlepool Hull Teaching Knowsley Tameside and Glossop North Tyneside Middlesbrough Redcar and Cleveland Sefton South Tyneside Stoke on Trent Teaching Sunderland Teaching Issue 1: January

26 (ii) Benchmarking provision of NHS Wirral pharmacy services NHS Wirral has 86 community pharmacy contractors which are located on high streets, in health centres, supermarkets and villages throughout the PCT area. There is better access to pharmaceutical services in Wirral when compared with our peers. In preparing this PNA we also found that most pharmacy premises in Wirral are well placed to deliver additional services, we found that over 80% of our pharmacies have a private area where they can deliver personal healthcare services to patients in privacy, something patients consider an important pre-requisite of extending the role of community pharmacists (Patient s Association, 2008). We can set the provision of pharmacy services in NHS Wirral into context by using national benchmarks which are available to the PCT. The table below shows the data for NHS Wirral and together with all PCTs in the North West SHA using nine indicators. The indicators are explained below and 2008/9 is the latest available data because 2009/10 data are not expected until November Guide to comparative indicators: Number of community pharmacies This is the number which was returned to the NHS Information Centre for 2008/09 by the PCT % Independent contractors This is the number of contractors belonging to chains of 5 or fewer pharmacies as determined by the Prescription Pricing Division (PPD) at 31 st March Households without access to a car (%) This is the % of all households in the PCT that reported in the 2001 census that they did not have access to a car Population / Hectare (2008/09) Pharmacies per 100,000 population Prescription items per pharmacy (month) This is the population density calculated using the ONS estimates of the area covered by the PCT and the ONS 2007 mid-year population estimates. This is the number of pharmacies at 31 st March 2009 per 100,000 population using the ONS mid-year estimates for 2008 This is the average of the number of prescription items dispensed by a pharmacy in the PCT calculated by the PPD in 2008/09 Number of community pharmacies This is the number which was returned to the NHS Information Centre for 2008/09 by the PCT MURs per provider (2008/09) This is the average number of MURs claimed per provider of Advanced Services in 2008/09 Issue 1: January

27 Table 1: Pharmacy characteristics in North West SHA PCTs PCT Number of community pharmacies % Independent contractors Households without access to a car (%) Population / Hectare (2008/09) Pharmacies per 100,000 population Prescription items per pharmacy (month) Advanced services (%) MURs per provider (2008/09) Ashton, Leigh and Wigan 67 36% 28% ,369 85% 144 Blackburn with Darwen Teaching 38 39% 33% ,386 79% 149 Blackpool 42 21% 37% ,106 57% 145 Bolton 62 29% 30% ,002 68% 129 Bury 36 39% 26% ,259 78% 182 Central & Eastern Cheshire 89 19% 18% ,550 88% 146 Central Lancashire 92 25% 23% ,547 84% 132 Cumbria % 24% ,487 80% 130 East Lancashire 90 32% 28% ,341 83% 128 Halton and St Helens 73 41% 30% ,174 64% 145 Heywood, Middleton & Rochdale 46 26% 33% ,891 87% 127 Knowsley 33 24% 42% ,757 94% 189 Liverpool % 48% ,013 79% 158 Manchester % 48% ,752 72% 154 North Lancashire 70 41% 24% ,208 80% 122 Oldham 47 45% 34% ,245 74% 176 Salford Teaching 54 28% 39% ,708 81% 183 Sefton 69 43% 31% ,879 80% 135 Stockport 63 29% 24% ,213 75% 113 Tameside and Glossop 50 28% 32% ,287 86% 166 Trafford 57 39% 25% ,021 88% 154 Warrington 42 29% 21% ,516 83% 151 Western Cheshire 53 32% 21% ,765 79% 145 Wirral 86 35% 30% ,871 81% 145 ENGLAND 10,475 38% 27% ,129 83% 161 North West 1,606 33% 30% ,674 79% 146 Source: NHS Information Centre, 2009 Issue 1: January

28 Table 2: Pharmacy characteristics in the Industrial Hinterlands ONS cluster group NHS Wirral PCT Number of community pharmacies % Independent contractors Households without access to a car (%) Population / Hectare (2008/09) Pharmacies per 100,000 population Prescription items per pharmacy (month) Advanced services (%) MURs per provider (2008/09) County Durham % 31% ,593 79% 136 Darlington 18 17% 31% ,726 72% 101 Gateshead 46 30% 43% ,417 80% 151 Halton and St Helens 73 41% 30% ,174 64% 145 Hartlepool 19 26% 39% ,829 84% 146 Hull Teaching 67 27% 44% ,337 91% 183 Knowsley 33 24% 42% ,757 94% 189 Middlesbrough 27 19% 41% ,200 93% 155 North Tyneside 50 26% 37% ,353 74% 195 Redcar and Cleveland 22 45% 32% ,024 68% 163 Sefton 69 43% 31% ,879 80% 135 South Tyneside 33 61% 44% ,654 73% 163 Stoke on Trent Teaching 61 33% 34% ,876 92% 175 Sunderland Teaching 57 49% 40% ,213 68% 190 Tameside and Glossop 50 28% 32% ,287 86% 166 Wirral 86 35% 30% ,871 81% 145 ENGLAND 10,475 38% 27% ,129 83% 161 ONS cluster % 35% ,310 80% 159 Source: NHS Information Centre, 2009 Issue 1: January

29 NHS Wirral pharmacy services relative to SHA, ONS cluster and England averages Using the comparative indicators that are available we can see that access to pharmacy services in Wirral is better than in other, comparable PCTs. This is demonstrated by the higher number of pharmacies per head of population (Wirral: 28 per 100,000) when compared with our ONS cluster group (ONS: 23 per 100,000 population) and the lower average dispensing volumes (Wirral: avg. 5,871 items per month) when compared to our ONS cluster group (ONS: avg. 7,310 per month). Table 3: Benchmarking NHS Wirral against selected indicators Indicator NHS Wirral NW PCTs ONS cluster PCTs England % Independent contractors 35% 33% 37% 38% Households without access to a car (%) Population / Hectare (2008/09) Pharmacies per 100,000 population Prescription items per pharmacy (month) 30% 30% 35% 27% ,871 6,674 7,310 6,129 Advanced services (%) 81% 79% 80% 83% MURs per provider (2008/09) Source: NHS Information Centre, Issue 1: January

30 (iii) Locality provision within NHS Wirral NHS Wirral organises pharmacies into three localities each consisting of between five and eight electoral wards. The locality areas used are: Bebington and West Wirral Birkenhead Wallasey The localities of Birkenhead, Wallasey and Bebington and West Wirral are used because this is currently the well established infrastructure of the PCT for GP practices, community services and social services. The next complete revision of the PNA in 2014 will use GP Consortia boundaries. The relationship between these areas and the wards making up NHS Wirral are as follows: Locality Bebington and West Wirral Birkenhead Wallasey Wards Bebington Bromborough Clatterbridge Eastham Greasby, Frankby and Irby Heswall Hoylake and Meols Pensby and Thingwall West Kirby and Thurstaston Bidston and St James Birkenhead and Tranmere Claughton Moreton West and Saughall Massie Oxton Prenton Rock Ferry Upton Leasowe and Moreton East Liscard New Brighton Seacombe Wallasey Source: NHS Wirral and ONS administrative geography 2009 The localities do not map precisely to ward boundaries, this affects the Birkenhead locality most with five pharmacies that are allocated to Birkenhead falling into wards that are allocated for practical purposes to the other two localities: Issue 1: January

31 Ward Number of pharmacies Locality Bebington 1 Bebington and West Wirral Bromborough 2 Bebington and West Wirral Leasowe and Moreton East 1 Wallasey Seacombe 1 Wallasey See the Appendix 3 for the allocation of individual pharmacies to wards and localities. Assessing pharmacy distribution within Wirral The location of pharmacies is influenced by the population density, the proximity to GP practices, also to the location of primary and secondary shopping areas and major transport routes. There are two benchmarking measures that we can use to assess the distribution of pharmacies at a locality level in order to understand the relative access for our population, these are: Pharmacies in relation to population size Average prescription volumes The combination of these two measures provides a basis for assessing the adequacy of distribution of pharmacies between localities in Wirral. Analysis by locality shows that the high levels of provision found across Wirral are also found at locality level. The number of pharmacies per head of population in each of the localities is greater than the English and ONS cluster averages. There are no dispensing doctor practices, internet pharmacies or appliance contractors within Wirral. The average number of prescriptions per pharmacy is also a useful measure of demand and distribution. Wirral pharmacies dispense fewer prescriptions than pharmacies in the ONS cluster. These data suggest that in Wirral there is capacity in our community pharmacy network to absorb additional work as our population grows. Table 4: Pharmacies per head of population by locality Pharmacies per 100,000 resident population Prescriptions per pharmacy (monthly average) 2008/09 Bebington and West Wirral 28 5,710 Birkenhead 29 6,171 Wallasey 24 6,854 NHS Wirral ,871 ONS cluster ,310 England ,129 *Locality level figures are derived from data collected by the PCT and may not correlate with the NHS Information Centre statistics presented previously. Issue 1: January

32 Unless otherwise annotated then the data presented below are derived from a postal questionnaire sent to all pharmacies in NHS Wirral in July Access to pharmacy services Opening hours of community pharmacies adapt to the demands of the local population and are influenced by the opening hours of GP services. Current supplementary pharmacy opening hours held by the PCT show that there is good access throughout the week and at weekends across Wirral which reflects both the urban nature of the localities and the presence of supermarket pharmacies and 100 hour pharmacies. The only time additional hours are funded via a rota is at Christmas. Provision at Easter has been considered but no concerns or complaints have been raised to date about lack of provision. This will be kept under review. Table 5: Pharmacy opening hours in Wirral by locality Weekday Saturday Sunday Open Close Open Close Open Close Bebington and West Wirral 08:30 21:00 08:30 20:00 09:00 16:00 Birkenhead 06:30 23:00 06:30 22:30 09:00 22:00 Wallasey 08:00 22:00 08:00 22:00 10:00 16:00 Very few pharmacies close during the working week having a negligible effect on access. A detailed breakdown of pharmacy opening hours is set out in Appendix 4. Table 6: Pharmacy half day closures in Wirral by locality Pharmacies Mon Tue Wed Thu Fri Bebington and West Wirral Birkenhead Wallasey Some pharmacies do not open on Saturdays and most do not open on Sundays, some of the pharmacies that open on Saturdays close in the afternoon. Looking at provision at weekends by locality we can see that there is a marked drop in provision on Saturday afternoons but that most communities maintain good access to services into Saturday afternoon. GP surgeries closing on a Saturday following the introduction of their new contract in 2004 has resulted in pharmacies closing, either all day or half day on Saturdays, due to lack of prescription dispensing activity. Fewer pharmacies open in Wallasey on Saturdays. 35% remain open on Saturday afternoon compared with around half of all pharmacies in Bebington and West Wirral and Issue 1: January

33 Birkenhead. However, the 100 hour contract and voluntary extended hours pharmacies in each locality mean that there is always service provision on Saturday and Sunday. Any change to the opening hours of these pharmacies will have a detrimental effect on access and service provision. Table 7: Pharmacy weekend opening in Wirral by locality Pharmacies Open on Saturday Open after 1pm on Saturday Open on Sunday Bebington and West Wirral Birkenhead Wallasey Provision of pharmacy services outside of core General Medical Services (GMS) hours can help to retain demand in primary care. Wirral has extensive pharmacy provision outside of core GMS hours which can be built upon to deliver services to patients. Recommendation: The equitable access initiative will have changed the pattern of GP opening hours, an audit comparing GP opening hours with pharmacy opening hours is needed to ensure that there continues to be joined up provision for patients. Some pharmacies close for one hour at lunchtime, usually between and 14.00, when we examine opening over the lunchtime period we see that in most localities around half of all providers open at lunchtime. Wallasey is the exception, one quarter of pharmacies in Wallasey remain open at lunchtime. Feedback from patients nationally is that where pharmacies close at lunchtime then that closure should be co-ordinated with other pharmacies in the area so that there is limited overlap and therefore always an alternative for patients who need pharmacy services at that time. Note: We have not received any complaints about access to pharmacies over lunchtimes. Table 8: Pharmacies that are open at lunchtime in Wirral by locality Pharmacies Mon Tue Wed Thu Fri Bebington and West Wirral Birkenhead Wallasey Availability of the pharmacist In response to a question in the survey most pharmacies reported that the pharmacy was open continuously throughout the day and that the pharmacist was available whenever the pharmacy was open. In some cases the pharmacy remains open but the pharmacist takes a set break which means that prescriptions and over the counter medicines cannot be sold during that time. Issue 1: January

34 Table 9: Pharmacist availability throughout the opening hours Pharmacist available throughout the opening hours Bebington & West Wirral 9 30% Birkenhead Wallasey Wirral % 6% 27% Recommendation: We will review lunchtime closure patterns to identify communities where co-ordination of lunch time closure between pharmacies would be beneficial so that closures do not overlap in order to improve access for patients. Languages spoken in Wirral PCT pharmacies Wirral has a relatively homogenous population, most of whom describe themselves as White English, however there is a small and discrete population from the black and minority ethnicities (BME) groups. There are translation services in place to support patients who do not speak English make use of NHS services. Wirral MBC figures show that the most common languages spoken in Wirral other than English are as set out in the table below. Table 10 shows the languages that pharmacists reported their patients speak, table 11 shows which languages are spoken by pharmacists and their staff. Table 10: Languages spoken by customers visiting Wirral pharmacies Bebington & West Wirral Birkenhead Wallasey Wirral n % n % n % n % Arabic 1 3.3% 1 6.3% % 8 9.3% Bengali 0 0.0% 0 0.0% % 6 7.0% Chinese % % % % French % 1 6.3% 1 2.5% 6 7.0% Somali 0 0.0% 0 0.0% 0 0.0% 0 0.0% Other % % % % Other languages spoken included; Polish, Greek, Irish, Hindi, Punjabi, Urdu, Turkish, Albanian, Spanish, German, Gujarati, and Hungarian Table 11: Languages spoken by staff working in Wirral pharmacies Bebington & West Wirral Birkenhead Wallasey Wirral n % n % n % n % Arabic 0 0.0% 2 5.0% 0 0.0% 2 2.3% Bengali 0 0.0% 0 0.0% 0 0.0% 0 0.0% Chinese 1 3.0% 2 6.7% 1 6.0% 4 4.7% French 0 0.0% 0 0.0% 0 0.0% 0 0.0% Somali 0 0.0% 0 0.0% 0 0.0% 0 0.0% Other % % 0 0.0% 8 9.3% Issue 1: January

35 Other languages include Hindi (1), Punjabi (2), Greek (1), Spanish (1), Italian (1), Gaelic (1) and Polish (1) Pharmacy infrastructure Pharmacy premises are increasingly modern, health focused and flexible, able to support a diverse range of NHS services in an accessible setting. Pharmacists and their teams have developed a broad range of skills and competencies which have supported a shift in emphasis from transactional services like dispensing to consultation based services Private or semi-private consultation facilities are currently used by community pharmacists to provide enhanced services, advanced services and consultations arising from the dispensing of prescriptions or sale of medicines. 90.7% of community pharmacies have a consultation area with four pharmacies (4.7%) planning one in the future and plans of the remainder unknown. Achieving 100% provision is likely to be constrained by the size and flexibility of existing premises. Table 12: Distribution of consultation facilities in pharmacies in Wirral Bebington & West Wirral Private consultation area More than one consultation area Plan to introduce a consultation area in the future Currently use consultation room for other practitioners to run clinics or services Willing to allow other practitioners to use your consultation room 96.7% 10.0% 0% 0.0% 66.7% Birkenhead 87.2% 2.5% 7.7% 10.0% 47.5% Wallasey 88.2% 6.3% 5.9% 0.0% 37.5% Wirral 90.7% 5.8% 4.7% 4.7% 52.3% Around 6% of pharmacies have more than one consultation area. There is some fledgling activity from these consultation areas by other practitioners and there is willingness to offer consultation areas in pharmacies as potential outposts for other practitioners. Most of the consultation areas in Wirral (82.6%) meet the requirements of the advanced services standards and around 76.7% of the consultation facilities are accessible to the disabled, however accessibility is poorest in the Birkenhead area. Some of our community pharmacies have invested in advanced consultation facilities in anticipation of future commissioning these include 40.7% with a sink and 48.8% with a computer terminal with access to the pharmacy s records. 52.3% of the community pharmacies already allow or would be willing to allow other practitioners to use the consulting room facilities. Issue 1: January

36 Table 13: Characteristics of pharmacy consultation areas in Wirral Bebington & West Wirral NHS Wirral Birkenhead Wallasey Wirral Consultation area clearly signposted 93.3% 82.5% 68.8% 83.7% Conversations cannot be overheard 93.3% 80.0% 81.3% 84.9% Seating is available 93.3% 82.5% 81.3% 86.0% Meeting all three above 93.3% 80.0% 68.8% 82.6% Area is accessible to the disabled 86.3% 79.4% 93.3% 84.6% There is a sink 41.4% 52.9% 46.6% 47.4% Access to toilet facilities 27.6% 17.7% 53.3% 28.2% Computer terminal 60.0% 55.0% 50.0% 55.8% Access to internet 56.7% 50.0% 50.0% 52.3% Possible to access PMR on computer 60.0% 42.5% 43.8% 48.8% Recommendation: we will work with our pharmacies to identify ways in which consultation facilities can be fully utilised for the benefit of our population and in particular for patients with a disability across Wirral and particularly in Birkenhead. Continuity of pharmacy staff Over 87% of pharmacies have regular pharmacists working in them, whether they are owners, managers, or regular locums. Tenure in Bebington and West Wirral is strongest with 93% of respondents being owner managers or permanent employees. Table 14: Pharmacist tenure at Wirral pharmacies Pharmacist type Owner / Manager Permanent employee Regular locum Bebington & West Wirral Birkenhead Wallasey Wirral % 42.5% 50.0% 43.0% % 37.5% 31.3% 41.9% % 0.0% 0.0% 2.3% Total regular pharmacists 100.0% 80.0% 81.3% 87.2% Did not answer % 20.0% 18.7% 12.8% Consistency of tenure is an advantage when commissioning and maintaining services from pharmacies. Issue 1: January

37 Around 55% of the regular pharmacists employed have worked in their pharmacy for three or more years. Table 15: Pharmacist continuity at Wirral pharmacies How long has this pharmacist worked here? Less than one year One to Two years Three to four years Five or more years Don t know Did not answer Bebington & West Wirral Birkenhead Wallasey Wirral % 15.0% 0.0% 15.1% % 17.5% 18.8% 17.4% % 10.0% 31.3% 16.3% % 37.5% 31.3% 38.4% % 2.5% 0.0% 1.2% % 17.5% 18.8% 11.6% Continuity is best in Bebington and West Wirral and Wallasey (both having 60% or more of pharmacists in post for more than three years) and lowest in Birkenhead where less than 50% have been in post for three or more years. A recent national survey by the Patients Association highlighted the concerns of patients with pharmacist or pharmacy staff turnover which is perceived as a barrier to extending the role of the pharmacist. Finally, 41.9% of pharmacists have not changed post in the last five years, demonstrating that there is some stability in the pharmacy workforce. Table16: Pharmacist continuity at Wirral pharmacies five year How many times has the regular pharmacist changed in the last 5 years Never Once Twice Three times More than three times Bebington & West Wirral Birkenhead Wallasey Wirral % 42.5% 37.5% 41.9% % 15.0% 25.0% 19.8% % 7.5% 12.5% 10.5% % 7.5% 0.0% 5.8% % 5.0% 6.3% 7.0% Issue 1: January

38 Don't know Did not answer % 5.0% 0.0% 3.5% % 17.5% 18.8% 11.6% Relationships with GPs The availability of a regular pharmacist also encourages good relationships with local GPs and other healthcare professionals. This is reflected in the fact that almost 90% of pharmacists rate their relationships with local GPs as Good or Very Good. Table 17: Pharmacies rating of relationship with main GP Rate relationship with local GP practice Bebington & West Wirral Birkenhead Wallasey Wirral Very Poor Poor Good Very Good Did not answer % 2.5% 0.0% 1.2% % 7.5% 0.0% 4.7% % 50.0% 37.5% 48.8% % 40.0% 56.3% 44.2% % 0.0% 6.3% 1.2% Relationships with GPs reflect the frequency and extent of contact between community pharmacists and the GPs that care for their patients. 37.2% will have spoken only once or twice to local GPs over the telephone. Table 18: Frequency of telephone contact between pharmacists and GPs. Spoken to GP over the telephone Bebington & West Wirral Birkenhead Wallasey Wirral Never Once or twice Weekly More often than weekly % 15.0% 0.0% 10.5% % 25.0% 50.0% 37.2% % 32.5% 25.0% 26.7% % 20.0% 25.0% 22.1% Issue 1: January

39 Don't know Did not answer % 5.0% 0.0% 2.3% % 2.5% 0.0% 1.2% It is also reported that 34.9% of pharmacies have never had a face to face meeting with local GPs. Table 19: Frequency of face-to-face contact between pharmacists and GPs. Spoken to GP face to face Bebington & West Wirral Birkenhead Wallasey Wirral Never Once or twice Weekly More often than weekly Don't know Did not answer % 35.0% 31.3% 34.9% % 22.5% 43.8% 27.9% % 5.0% 12.5% 9.3% % 20.0% 0.0% 14.0% % 5.0% 0.0% 2.3% % 12.5% 12.5% 11.6% The generally good relationship ratings were evident despite the fact that 34.9% of the pharmacists had never had a face to face meeting with their main GP practice, this is something that the pharmacists reflected on when we asked how the PCT could foster closer links between GPs and pharmacists. Most suggesting that there is a need for joint meetings to be facilitated by the PCT. Recommendation: we will work with our pharmacists and GPs to create better opportunities for joint working and networking in order to develop existing local relationships. We will focus on initiatives where there is common ground such as repeat dispensing and medicine use reviews. Recommendation: we will emphasise in our commissioning the importance of continuity and consistency of pharmacist provision to ensure that the experience of patients reflects our aspirations. Issue 1: January

40 Essential Services All community pharmacies provide the essential services required by the community pharmacy contractual framework. The number of pharmacies per 100,000 population in Wirral is higher than average and the prescriptions dispensed per pharmacy is lower than average. However, pharmacists reported that the burden of dispensing and record keeping is presenting a barrier to making routine healthy lifestyle interventions, which also form part of the essential services element of the contract. Table 20: Barriers to making interventions Other pressures of work Paperwork and record keeping Confidence/ experience of making interventions Supporting materials and resources Strongly Disagree 2.3% 0.0% 24.4% 9.3% Disagree 9.3% 12.8% 51.2% 34.9% Neither 7.0% 12.8% 15.1% 29.1% Agree 48.8% 43.0% 8.1% 25.6% Strongly Agree 32.6% 31.4% 1.2% 1.2% Other pressures of work and the administration associated with making interventions are perceived as the most significant barrier for contractors. This is important because the PCT s priorities will require the support of a strong public health intervention programme in community pharmacy. The picture is not uniform across the PCT but there is generally consistency in the message from contractors. Respondents in Wallasey were least likely to report that other pressures were an obstacle, conversely this is also the locality which has the highest prescriptions items per pharmacy (see table 4, previous). However respondents from Wallasey were more likely to cite confidence in making interventions as a barrier. Table 21: Barriers to making interventions - Combined Agree and Strongly Agree responses Bebington & West Wirral Birkenhead Wallasey Wirral Other pressures 83.3% 82.5% 75.0% 81.4% Paperwork 66.7% 75.0% 87.5% 74.4% Confidence 3.3% 7.5% 25.0% 9.3% Supporting materials 16.7% 27.5% 43.8% 26.7% Recommendation: we will work with our pharmacists to identify mechanisms to share best practice in undertaking interventions and dealing with pressures of work which present a barrier to activity. Issue 1: January

41 Repeat dispensing Repeat dispensing is seen as a transitional step on the pathway to electronic repeat prescribing which will be introduced with the implementation of Electronic Prescription Service (EPS) Release 2. This will allow GPs to generate paperless repeat prescriptions which will be managed by the pharmacist for the patient. Uptake of repeat dispensing has been poor across the country since its introduction in However the imminent implementation of EPS Release 2 has focused attention onto repeat dispensing as it provides an opportunity to implement the underlying processes before the technology is introduced to make it a paperless process. The risk of poor uptake of repeat dispensing is that GPs and pharmacies will struggle to cope with implementation of EPS Release 2. Due to technical problems early on in the implementation, GP uptake of repeat dispensing has been low. However, the PCT s RD activity has grown steadily and at a marginally faster pace than in the SHA, however the PCT is lagging behind both the ONS cluster and the national picture. Table 22: Repeat dispensing activity benchmarking % RD items 2006/07 % RD items 2007/08 % RD items 2009/10 Wirral 0.56% 0.88% 1.33% NW SHA 0.33% 0.62% 1.23% ONS Cluster 0.76% 1.45% 3.43% England 0.86% 1.58% 2.94% Source: FOI request to PPD. % of all items which were written as repeat dispensing items The implementation of repeat dispensing is a significant enabler in embedding the core contractual services and enabling new services to develop. While good progress has been made, the absolute number of repeat dispensing prescriptions issued remains low. Recommendation: we will encourage our pharmacy contractors to develop a strategy for redesigning dispensing activity through technology and skills mix to ensure that we maximise the potential of the community pharmacist and reduce barriers to new roles. Community pharmacy patient questionnaire As part of the essential services community pharmacists are required to carry out an annual patient questionnaire. Whilst most community pharmacies surveyed in 2008 have either done this (69.8%) or are doing it (22.1%) many have found this difficult, particularly due to other pressures of work. From our findings in 2010 all community pharmacies have carried out at least one CPPQ. 76 pharmacies (88.4%) have voluntarily submitted a summary of their findings to the PCT, which is not required by the contract and demonstrates the excellent relationship between the Medicines Management Team and local contractors. Issue 1: January

42 Table 23: Progress in completing annual survey of patients - CPPQ (2008) NHS Wirral Completed survey of patients Bebington & West Wirral Birkenhead Wallasey Wirral Completed Underway Not yet started Did not answer % 60.0% 68.8% 69.8% % 32.5% 18.8% 22.1% % 7.5% 6.3% 7.0% % 0.0% 6.3% 1.2% Table 24: Barriers to undertaking CPPQ - Combined Agree and Strongly Agree responses Bebington & West Wirral Birkenhead Wallasey Wirral Preparing materials 10.0% 5.0% 12.5% 8.1% Entering data 16.7% 10.0% 0.0% 10.5% Analysis of data 20.0% 20.0% 18.8% 19.8% Other pressures of work 50.0% 55.0% 25.0% 47.7% Confidence to approach patients 10.0% 15.0% 6.3% 11.6% Advanced Services In Wirral 81% of community pharmacies actively provide the advanced services - medicines use reviews (MUR) and prescription interventions. The number of MURs carried out has been rising steadily since their introduction in The Appliance Use Reviews and Stoma Appliance Customisation services are newly introduced advanced services. Progress in the uptake of MUR has been rapid across England. Growth in activity in Wirral has kept pace with the national growth. The number of providers being marginally better but the level of activity per provider being marginally poorer, the combined effect is to make Wirral PCT in line with the national average in terms of overall provision of MUR. Table 25: Advanced services uptake benchmarking Wirral and England 2005/ / / /09 Wirral MUR activity / provider Percentage of pharmacies providing % 53% 73% 81% Issue 1: January

43 England MUR activity / provider Percentage of pharmacies providing 39% 62% 69% 83% Source: NHS Information Centre, 2009 Comparing Wirral PCT to peer PCTs using the ONS cluster group shows that our PCT currently has similar levels of accredited pharmacies (81%) against an average of 80% for the peer group. Table 26: Advanced services uptake benchmarking ONS cluster Pharmacies per 100,000 pop Prescriptions per pharmacy (month) Advanced services accredited pharmacies (%) MURs per provider ( ) County Durham ,593 79% 136 Darlington ,726 72% 101 Gateshead ,417 80% 151 Halton and St Helens ,174 64% 145 Hartlepool ,829 84% 146 Hull Teaching ,337 91% 183 Knowsley ,757 94% 189 Middlesbrough ,200 93% 155 North Tyneside ,353 74% 195 Redcar and Cleveland ,024 68% 163 Sefton ,879 80% 135 South Tyneside ,654 73% 163 Stoke on Trent Teaching ,876 92% 175 Sunderland Teaching ,213 68% 190 Tameside and Glossop ,287 86% 166 Wirral ,871 81% 145 ENGLAND ,129 83% 161 ONS cluster ,310 80% 159 Source: NHS Information Centre, 2009 Data for Wirral PCT using recent local data (note comparator data for 2009/10 is not available until Nov 2010). Table 27: Advanced services activity benchmarking by locality Advanced services active pharmacies (%) 2007/08 MURs per provider ( ) Advanced services active pharmacies (%) 2009/10 MURs per provider (2009/10) Bebington and West Wirral 87% % 213 Birkenhead 73% % 193 Wallasey 75% % 134 Wirral 78% 133* 85% 190 Issue 1: January

44 Source: NHS Wirral (*note these figures will not match the data in Table 36 due to being derived from a different source) However there is significant variation in the number of active providers at local level. Table 28: Advanced services activity locality level Bebington and West Wirral 09/10 Birkenhead 09/10 Wallasey 09/10 Wirral 09/10 Pharmacies Accredited for MUR 97% 87% 88% 88% Percentage performing MUR (>0 claims in 12 months) Percentage performing MUR consistently (>50 claims in 12 months) 87% 82% 86% 85% 60% 67% 53% 64% MUR per annum / pharmacy Min MURs in any one pharmacy Max MURs in any one pharmacy Source: NHS Wirral These gaps provide the potential to grow provision in Wirral in a number of ways; by encouraging accredited providers to become active and by encouraging inconsistent providers to be more consistent. Pharmacists cited practical, operational reasons for the low uptake of MUR in their pharmacy, they felt that they were equipped in terms of skills and confidence but that other work and the acceptance of patients and GPs stopped them doing more MURs. The number of MURs that a pharmacy may provide is currently limited to 400 per annum, giving a maximum potential activity of 34,400 in Wirral. In 2009/10 pharmacies in Wirral conducted 13,713 reviews or 40% of the potential maximum. The provision of MURs has grown incrementally each year. Table 29: Barriers to undertaking advanced services Other pressures of work e.g. dispensing Bebington & West Wirral Birkenhead Wallasey Wirral 90.00% 72.50% 81.30% 80.20% Patients refusing invitation 66.70% 47.50% 31.30% 51.20% No feedback from GPs 63.30% 47.50% 25.00% 48.80% Don't see eligible patients because of collection and delivery 53.30% 37.50% 37.50% 43.00% Issue 1: January

45 Patients do not turn up for appointments NHS Wirral 50.00% 35.00% 18.80% 37.20% Paperwork takes too long 36.70% 37.50% 31.30% 36.00% Difficult to identify patients 30.00% 25.00% 18.80% 25.60% Premises not accredited 10.00% 17.50% 12.50% 14.00% Pharmacist not accredited 3.30% 17.50% 12.50% 11.60% Confidence to approach patients 13.30% 10.00% 12.50% 11.60% Confidence/experience of undertaking MURs Knowledge or skills to provide MURs 6.70% 12.50% 12.50% 10.50% 3.30% 7.50% 0.00% 4.70% While the PCT has no power to direct pharmacists to undertake MUR with specific patient groups, PCTs and LPCs are encouraged to discuss and agree which patients are a high priority for the PCT. This PCT has been successful in engaging pharmacies and the LPC to accept referrals triaged for MUR from the PCT s medication review service. Prior to this development the PCT encouraged pharmacies to focus on patients with asthma, COPD, osteoporosis, prescribed methotrexate and diabetic testing strips. Pharmacists in Wirral reported that they are focused on asthma and diabetic patients. Table 30: Pharmacist s reported priorities for advanced services Patient group Number of respondents Asthma 16 Diabetes 12 Cardiovascular/Hypertension 8 COPD 7 Osteoporosis 5 Elderly 3 Anticoagulants 2 Recommendation: we will work to increase MUR activity by increasing the number of pharmacies that are accredited to provide MUR, and by encouraging consistent activity in accredited pharmacies. We will also work with our pharmacists to link the provision of MUR with the PCT s long term conditions strategy, particularly around patient education and improving adherence in long term conditions. We will increase the number of MUR referrals, triaged via the Medicines Management Medication Review Referral Service, for both pharmacy-based and domiciliary MURs Issue 1: January

46 Enhanced Services Wirral PCT has been active in commissioning enhanced services from community pharmacy contractors and has achieved national profile for its work to deliver public health focused enhanced services. The PCT commissions a range of services which have been developed to build on the skills of the community pharmacists and to support the PCT to deliver on the priorities for the population. NHS Wirral commissions the following enhanced services according to need: Those based on the health needs of the local population: o Supervised consumption (75 pharmacies 87%) o Needle exchange (19 pharmacies 22%) o Emergency contraception + (28 pharmacies 33%) o Alcohol screening (63 pharmacies 73%) o Smoking cessation (61 pharmacies 71%) o Weight management (31 pharmacies 36%) Other enhanced services: o Advice to care homes (17 pharmacies 20%) o Sharps disposal for patients self-injecting insulin/other medicines (85 pharmacies 99%) o Palliative care medicines access (11 pharmacies 13%) o Dressings stock supply to community nurse bases (19 pharmacies 22%) Commissioning each enhanced service takes significant effort on the part of the PCT and contractors. As the service becomes embedded the focus shifts to ensuring that the service continues to meet the needs of the population and the objectives set when it was first developed and commissioned. The tables below show that there is consistent commissioning across the PCT in terms of the spread and number of providers. However when we look at levels of activity levels we see that there is a gap between the PCT s commissioning intentions and the provision in practice. Source: the data in the tables describing each service are derived from activity data collected by the PCT. Issue 1: January

47 Enhanced services commissioned to meet health need Reference is made to additional non-pharmaceutical providers where this is relevant for each enhanced service. This detail is listed in the following section. (i) Pharmaceutical Providers Supervised consumption for drug misuse clients: This service is client-led and dependant on referrals from Wirral Drug Service. Pharmacy is the only provider for this service. Table 31: Distribution of supervised consumption services in Wirral Supervised consumption 2009/10 Pharmacies Accredited Service Accessed 2009/10 Bebington and West Wirral 25 83% 9 36% Birkenhead 36 92% 29 81% Wallasey 14 82% 10 71% Wirral 75 87% 48 64% Needle exchange for drug misuse clients: this is commissioned where there is a need. There is lower commissioning in Bebington and West Wirral, and this reflects the need for exchange services being concentrated in Wallasey and Birkenhead. All providers commissioned are active in providing the service. In addition the PCT also commissions non-pharmaceutical providers for this service. Table 32: Distribution and activity for needle exchange services in Wirral Needle Exchange 2009/10 Pharmacies Accredited Service Accessed 2009/10 Bebington and West Wirral 4 13% 4 100% Birkenhead 10 25% % Wallasey 5 31% 5 100% Wirral 19 22% % Emergency Hormonal Contraception + (EHC +): a similar percentage of pharmacies are commissioned to provide this service in all localities. This service is patient-led i.e. patients choose to access this service. 71% of pharmacies have had patients access the service, with the greatest activity in Birkenhead. In addition the PCT also commissions nonpharmaceutical providers for this service. Pharmacies who do not provide this service signpost patients to other providers. Table 33: Distribution and activity for pharmacy EHC+ services in Wirral EHC+ services 2009/10 Pharmacies Accredited Service Accessed 2009/10 Bebington and West Wirral 10 33% 5 50% Issue 1: January

48 Birkenhead 12 31% 11 92% Wallasey 6 35% 4 67% Wirral 28 33% 20 71% NHS Wirral Alcohol screening: this is one of the more recently commissioned services which is being used as a model of good practice in the North West. 90% of pharmacies in Birkenhead, 71% of pharmacies in Wallasey and 53% of pharmacies in Bebington and West Wirral are commissioned to provide the service. Activity levels are varied with more pharmacies active in Bebington and West Wirral than in Birkenhead and Wallasey. In addition the PCT also commissions non-pharmaceutical providers for this service. Table 34: Distribution and activity for pharmacy alcohol screening services in Wirral Alcohol Screening 2009/10 Pharmacies Accredited Service Provided 2009/10 Bebington and West Wirral 16 53% 6 38% Birkenhead 35 90% 12 34% Wallasey 12 71% 3 25% Wirral 63 73% 21 33% Smoking Cessation: this service is commissioned from 70% of all pharmacies. This service is well accessed with 100% of pharmacies being active. This service is patient-led with patients making their own choice of provider. In addition the PCT also commissions non-pharmaceutical providers for this service. Table 35: Distribution of smoking cessation services in Wirral Smoking Cessation 2009/10 Pharmacies Accredited Service Accessed 2009/10 Bebington and West Wirral 23 77% % Birkenhead 28 72% % Wallasey 10 59% % Wirral 61 71% % Weight Management: The Public Health Directorate commissioned providers on the basis of a tendering exercise. The Medicines Management Team bid was selected to provide the service for adult patients, sub-contracting to community pharmacy providers. This is commissioned from 36% of all pharmacies. 68% are active, with the greatest levels of activity in Bebington & West Wirral and Birkenhead. A number of pharmacies are awaiting training before being able to start to provide this service. This service is accessed via referral from other healthcare professionals. In addition the PCT also commissions nonpharmaceutical providers. Issue 1: January

49 Table 36: Distribution of weight management services in Wirral Weight Management 2009/10 Pharmacies Accredited Service Accessed 2009/10 Bebington and West Wirral 12 40% 9 75% Birkenhead 13 33% 9 69% Wallasey 6 35% 3 50% Wirral 31 36% 21 68% (ii) Non-pharmaceutical providers Refer to Appendix 5 for the list of providers Needle exchange for drug misuse clients: this is commissioned from the specialist services at the following locations: Harm Reduction Unit, Elm Road entrance, St Catherine s Hospital, Birkenhead Outreach clinics via the Harm Reduction Unit ARCH, 23 Conway Street, Birkenhead Emergency Hormonal Contraception + (EHC+): There are a variety of providers for this service including specialist services, the school nursing service and some specific sexual health clinics are offered at GP practices. The providers for this service are listed below: Wirral Brook Advisory Service St Catherine s Hospital Sexual Health Clinic Victoria Central Hospital walk in centre Eastham Clinic Arrowe Park Hospital Genito-urinary Medicine (GUM) Clinic All Day Health Centre The Lodge and Wirral Sexual Health Clinic St Georges Medical Centre Confidential Advice Service Claughton Medical Centre - GUM Birkenhead Sixth Form College Clinic Leasowe - Wirral Sexual Health Clinic Miriam Health Centre - Wirral Sexual Health Clinic Parkfield (New Ferry) Clinic Wirral Sexual Health Heswall Clinic Wirral Sexual Health West Kirby Clinic Wirral Sexual Health School Nurses also provide this service as part of Health Services in Schools (HSIS) In addition, GPs prescribe EHC on prescription to patients who present for consultation. EHC is also available for patients to purchase over the counter from community pharmacies. Alcohol screening: This service is delivered by other providers as follows: Community Mental Health Team, Victoria Central Health Centre The Social Partnership, St Pauls Road, Seacombe Issue 1: January

50 Adult mental Health, Stein Centre, St Catherine s Hospital Birkenhead One Stop Shop, Birkenhead Brassey Gardens Children s Centre, Birkenhead The Social Partnership, Moreton The Social Partnership, Rock Ferry Wirral Heart Support, St Catherine s Hospital Wirral Independent Living, Hind Street, Birkenhead NHS Wirral This service is provided by the following groups in rotating locations across Wirral. These are therefore not included on the maps: Advocacy in Wirral Age Concern Forum Housing Phoenix Futures Wirral ARK Project Health & Wellbeing Health Action Lifestyle & Weight Management Occupational Health This service is also provided by the following GP Practices: Blackheath Medical Centre, Leasowe Central Park Medical Centre, Wallasey Earlston Road Surgery, Wallasey Field Road Health Centre, Wallasey Grove Road Surgery, Wallasey Liscard Group Practice, Wallasey Manor Health Centre, Wallasey Mill Lane Surgery, Wallasey Wallasey Village Medical Centre, Wallasey Claughton Medical Centre, Claughton Cavendish Medical Centre Devaney Medical Centre, Oxton Fender Way Health Centre, Noctorum Gladstone Medical Centre, Birkenhead Greenway Road Surgery, Tranmere Hamilton Medical Centre, Birkenhead Heatherlands Medical Centre, Woodchurch Holmlands Medical Centre, Oxton Hoylake Road Medical Centre, Moreton Miriam Medical Centre, Birkenhead Moreton Health Centre Moreton Medical Centre Parkfield Medical Centre (Dr C), New Ferry Prenton Medical Centre Riverside Surgery, Birkenhead Victoria Park Health Centre, Birkenhead Villa Medical Centre, Prenton Issue 1: January

51 Vittoria Medical Centre (Dr M), Birkenhead Woodchurch Medical Centre, Woodchurch Woodchurch Road Surgery, Prenton Eastham Group Practice, Bromborough Allport Surgery, Bromborough Teehey Lane Medical Centre, Bebington Sandstone Medical Centre, West Kirby Pensby Surgery, Pensby Heswall Medical Centre, Heswall Smoking Cessation: There are a variety of providers for this service including the specialist services SUPPORT (who provide services in different locations throughout Wirral) and GP practices. West Kirby Library Leasowe Millennium Centre Eastham Clinic Albert Lodge, Victoria Central Hospital New Brighton Childrens Centre Bebington One Stop Shop Heswall Clinic Greasby Clinic Salvation Army Birkenhead Victoria Central Hospital, Wallasey 30 Argyle Street, Birkenhead Moreton Library St James Centre, Laird Street, Birkenhead This service is also provided within GP Practices as set out in appendix 5. There are 22 GP providers in Birkenhead, 18 in Bebington and West Wirral and 14 in Wallasey. Weight Management: The specialist services provide this service in a number of locations across Wirral as follows: Civic Medical Centre, Bebington The Concourse, West Kirby Westbourne Hall Community Centre, West Kirby West Kirby Methodist Church Alexander Hall, Heswall Ganney s Meadow, Woodchurch Early Years Centre, Woodchurch Birkenhead YMCA Leasowe Primary Care Centre Victoria Central Hospital, Wallasey 30 Argyle Street, Birkenhead St Catherine s Hospital, Tranmere Eastham Clinic Greasby Clinic Issue 1: January

52 All GP practices in Wallasey also provide this service. The PCT also commission Slimming World to provide a service to adults and Mind. Exercise. Nutrition. Do It! (MEND) for a service to children. These are provided from a variety of locations on different days. Other Enhanced Services: pharmaceutical providers Advice to care homes: around 20% of all pharmacies are commissioned to provide this service mainly in Birkenhead and Wallasey. This service was offered to all Wirral pharmacies that dispense for care homes. There are good levels of activity, with only a small number of pharmacies inactive in Birkenhead and Wallasey. 50% of care homes receive this service (77 out of 155). Community pharmacies are the only provider for this service. Table 37: Distribution and activity for advice to care homes services in Wirral Advice to care homes 2009/10 Pharmacies Accredited Service Provided 2009/10 Bebington and West Wirral 4 13% 4 100% Birkenhead 9 23% 7 78% Wallasey 4 24% 3 75% Wirral 17 20% 14 82% Dressings Service: this service is for the supply of dressings stocks to community nurse bases (all pharmacies dispense dressings on prescription). This service was commissioned by the Medicines Management Team to reduce dressings waste because excess dressings prescribed for individual patients cannot be used by nurses for other patients. Choice of provider is led by the community nurse bases. All providers are active. Pharmacy is the only provider for this service. Table 38: Distribution and activity for pharmacy dressings supply service in Wirral Dressings Service 2009/10 Pharmacies Accredited Service Accessed 2009/10 Bebington and West Wirral 4 13% 4 100% Birkenhead 10 26% 7 70% Wallasey 5 29% 2 40% Wirral 19 22% 13 81% Sharps service for patients self-injecting insulin and other medicines: this service is commissioned by the Medicines Management Team from all but one pharmacy and is subject to an automatic retainer. The service is funded by Wirral Metropolitan Borough Council to reduce the risk of these medicines being discarded in normal household waste. The Environmental Protection Act 1990 section 45 (1) Collection, Disposal or Treatment of Controlled Waste Regulation specifies that it shall be the duty of each waste collection authority to arrange for the collection of household waste in its area, except if the household Issue 1: January

53 is so isolated or inaccessible that the cost would be unreasonably high and the authority is satisfied that other adequate arrangements are in place. No activity measure is made in relation to the service. Pharmacy is the only provider for this service. Table 39: Distribution of pharmacy sharps services in Wirral Sharps Service 2009/10 Pharmacies Accredited Bebington and West Wirral 29 97% Birkenhead % Wallasey % Wirral 85 99% Palliative care medicines access: All pharmacies provide palliative care dispensing in response to prescriptions. In addition, the PCT commissions a small number of pharmacies (13%), with a good geographical spread, to carry an extended list of palliative care stock. This is in response to feedback from patients, community nurses and the specialist palliative care service to prevent patients visiting multiple pharmacies to access supplies of less commonly prescribed palliative care medication. The PCT funds any expired stock and there are no service fees. No activity measure is made in relation to the service. Pharmacy is the only provider. Table 40: Distribution of palliative care medicines access pharmacies in Wirral Palliative Care 2009/10 Pharmacies Accredited Bebington and West Wirral 5 17% Birkenhead 4 10% Wallasey 2 12% Wirral 11 13% Recommendation: We will audit activity at a locality level to identify gaps in provision across each enhanced service. We will ensure that our commissioning intentions in relation to enhanced services are reflected in the activity that we see from our community pharmacies by adopting minimum required activity in SLAs (for services where pharmacies invite patients to participate) Recommendation: We will identify pharmacies that are successfully delivering multiple enhanced services and work with them to share best practice with other providers. Issue 1: January

54 Contractor engagement in potential future service provision Pharmacy contractors were asked to state their willingness to provide a range of enhanced services if these were to be commissioned in the future by the PCT or practice based commissioning clusters/gp Consortia. This information should not raise expectations that these services will be commissioned. This was included in the July 2010 survey to assess the level of interest from existing contractors in future service provision. This information is relevant when considering an application for a new contract where a case is being made to address perceived unmet need. To provide some context examples of services that are currently commissioned in other areas nationally include: Table 41: Examples of pharmaceutical services commissioned in England Womens and childrens health Advisory services to children s homes or schools Emergency Hormonal Contraception Staying healthy Specialist health promotion Osteoporosis testing Weight management CHD risk assessment Nicotine Replacement Therapy Smoking cessation counselling Flu vaccination Acute care Minor ailments scheme Out of hours services General Medicines Management Prescription intervention recording and reporting scheme Medication review in the pharmacy Medication review in the practice Medication review in the patient s home Mental health Needle and syringe exchange Supervised consumption of methadone and others Benzodiazepine withdrawal support Long-term conditions Spirometry Anticoagulant monitoring and dosing Blood pressure monitoring Diabetes testing Cholesterol testing H Pylori testing Diabetes monitoring/support Supply of monitored dosage systems to domiciliary patients End-of-life care Advisory services to care homes Access to end of life medicines out of hours Sessional prescribing advice to GP practices Prescription collection service Prescription delivery service We asked community pharmacists to indicate their willingness to provide enhanced services in the future from this list. Please refer to Table 42. Issue 1: January

55 Table 42: Willingness to provide enhanced services in the future NHS Wirral Enhanced services - Willing to provide Wallasey BWW Birkenhead Wirral Minor ailments scheme, i.e. free of charge to the patient (where exempt) 76.5% 83.3% 87.2% 83.7% CHD risk assessment including measurement of blood pressure & lipids 82.4% 92.3% 96.9% 91.9% Emergency Hormonal Contraception under PGD i.e. free of charge to the patient 88.2% 94.9% 53.3% 53.4% Blood pressure monitoring 75.0% 86.7% 70.0% 76.7% Weight management e.g. weight monitoring & advice 47.0% 66.6% 63.3% 60.9% Chlamydia testing and tracing 82.3% 86.7% 82.1% 83.7% Diabetes testing 76.5% 83.3% 74.4% 76.7% Cholesterol testing 82.4% 83.3% 79.5% 81.4% Guaranteeing to hold a stock of, and providing access to, end of life medicines 75.0% 63.3% 62.5% 65.1% Sharps disposal service (non-needle exchange) 17.6% 33.3% 48.7% 37.2% Osteoporosis testing 62.5% 66.7% 57.5% 61.6% Diabetes monitoring/support e.g. regular tests & reviews 70.6% 83.3% 82.1% 80.2% Benzodiazepine withdrawal counselling support 56.3% 63.3% 55.0% 58.1% Anticoagulant monitoring e.g. blood test and reporting 76.5% 93.3% 89.7% 88.4% Nicotine Replacement Therapy through over the counter sale 43.8% 60.0% 55.0% 54.7% Supply of Nicotine Replacement Therapy on presentation of a voucher 43.8% 63.3% 52.5% 54.7% Medication review in the pharmacy 47.1% 64.1% 60.0% 68.6% Smoking cessation counselling e.g. Level 2 support 11.7% 13.3% 12.8% 12.8% Prescription intervention recording and reporting scheme 31.3% 66.7% 50.0% 52.3% Prescription collection service 100% 100% 97.4% 98.8% Alcohol screening and brief intervention service 29.4% 50.0% 25.6% 34.9% Medication review in the patient s home 23.5% 70.0% 56.4% 54.7% Prescription delivery service 100% 90.0% 84.6% 89.5% Spirometry 43.8% 53.3% 42.5% 46.5% Supply of MDS to domiciliary patients 50.0% 53.3% 40.0% 46.5% Flu vaccination 88.2% 82.1% 86.7% 84.9% Advisory services to care homes (over and above the Drug Tariff specification) 52.9% 63.3% 66.7% 62.8% Supervised consumption of methadone, Subutex or other treatments 5.9% 10.0% 12.8% 10.5% Sessional prescribing advice to GP practices 18.8% 53.3% 32.5% 37.2% Needle and syringe exchange 29.4% 13.3% 53.8% 52.3% Supply of MDS to care homes 37.5% 36.7% 30.0% 33.7% Advisory services to children s homes or schools 70.6% 76.6% 82.1% 77.9% Medication review in a GP practice 31.3% 43.3% 22.5% 31.4% Truss fitting service 12.5% 40.0% 15.0% 23.3% Services in bold are currently commissioned by the PCT from some pharmacies. Issue 1: January

56 The top five commissioned services in England are: Table 43: Benchmarking commissioning of enhanced services in Wirral (Source: NHS IC, 2009) % of PCT commissioning (England) % of PCT commissioning (ONS Cluster) Commissioned in Wirral Needle exchange 87% 56% Yes Supervised consumption 86% 75% Yes Smoking cessation 86% 81% Yes Minor ailments 62% 88% No EHC 63% 81% Yes Wirral does not currently commission a pharmacy minor ailments service. This service is commissioned in 56% of PCTs in England and 81% of PCTs in our ONS cluster group. Pharmacy minor ailment schemes are commissioned in PCTs to improve access to primary care services where this is considered to be inadequate. Various mechanisms are in place across Wirral to achieve high levels of access, including a Walk in Centre, All Day Health Centre and the GP access scheme. The 100-hour pharmacy contracts and extended hours pharmacies support this infrastructure. The need for a pharmacy minor ailments scheme will be kept under review, but this is not an identified need currently. A nationally commissioned service is also being considered by the Department of Health. Practice based commissioning clusters/gp Consortia may wish to consider this commissioning opportunity in the future to manage their workload and release their capacity to manage more complex patients in the community. Private provision of services from pharmaceutical providers Pharmacies provide both NHS funded care and services that are paid for directly by the patient. Some community pharmacies provide these non-nhs services to our population. These include: Over the counter medication, including supply of emergency hormonal contraception and smoking cessation Measurements like blood pressure, weight and height Diagnostic tests like cholesterol and blood glucose Pharmaceutical providers outside the pharmaceutical list Other than the contractors included on the NHS Wirral pharmaceutical list, the following provide pharmaceutical services. (i) (ii) Wirral Hospitals Pharmacy Department: there are bases at Arrowe Park and Clatterbridge hospitals providing a range of clinical services and a supply service for inpatients, on discharge and for hospital outpatient prescriptions. Cheshire and Wirral Partnership Trust Pharmacy Department: operates a range of clinical services to the mental health services wards and sub-contracts dispensing services. Issue 1: January

57 (iii) NHS Wirral Medicines Management Team: offers a clinical medication review service, a medicines information service, GP prescribing advice and medicines governance expertise, in addition to the commissioning of community pharmacy services. Patient Experience Current and future commissioning needs to be informed by, and sensitive to the views of patients. To provide some context for the PNA the following sources of information were used: the summary information submitted to the PCT by community pharmacies for the Community Pharmacy Patient Questionnaire (CPPQ) small-scale range of in-depth interviews with a cross section of patients Summary of the Community Pharmacy Patient Questionnaire The CPPQ is part of the essential services of the pharmacy contract and the information submitted by contractors was analysed to gauge patient satisfaction with pharmacy services and to identify if there were any areas where improvements were needed. Further detail is available in Appendix 7. There is no requirement for pharmacies to share outcomes from this satisfaction survey with the PCT however following our request, 72 pharmacies (84%) were willing to share a summary of their findings with us. The Pharmaceutical Services Negotiating Committee (PSNC) has provided a template to feedback this information to PCTs, where the pharmacy is willing. The template asks for the three areas where the pharmacy is performing most strongly and one area that provides the greatest potential for improvement. Pharmacies can use any method they choose for feedback and consequently the information received was in many formats, with some as templates and some as complete reports, some have used percentages to express the results and some have listed the areas with no quantitative measurers. Therefore, a direct comparison cannot be made. However we were able to draw some broad conclusions to give an indication of patients views of our pharmaceutical services. Areas in which pharmacies are performing strongly include: service received from the pharmacy staff the cleanliness of the pharmacy satisfaction with the time it took to provide prescriptions and/or any other NHS services required providing an efficient service being polite and taking time to listen From these results it appears that the pharmacy staff may be the biggest attribute valued by customers. Four of the top five scoring areas are directly influenced by the performance, skills and attitude of the staff. Areas identified as the area for greatest potential for improvement include: Providing general advice on leading a more healthy lifestyle Issue 1: January

58 Having somewhere available to speak without being overheard NHS Wirral The areas identified by contractors as the area for greatest improvement may not necessarily be the lowest scoring area but the areas within which the contractor feels that improvement can deliver the biggest impact to customer care. Summary of Interviews In-depth interviews were conducted with a cross section of 13 patients selected to reflect the different communities and health problems among our population. The purpose of this small-scale exercise was to explore the experience of using pharmacy services from the perspectives of participants. During the consultation period this is available on request from the PCT. Key findings The key findings are set out below. We have developed actions which we will take forward as we develop our plans for pharmacy in Wirral. Participants told us that they were generally loyal to a particular pharmacy which would, ideally be located close to their GP or where they shop. Generally, people associate pharmacy with the traditional core role of providing a prescription dispensing service and providing advice on minor illnesses While most agree with the premise of developing the role of pharmacists and their staff to help us to achieve our objectives, they were keen to ensure that we get the basics right by providing a safe, efficient and knowledgeable service around medicines and prescriptions. Awareness of the extended role that our pharmacies already play in Wirral was low. We could use patient loyalty to deliver more services through pharmacy Generally, enhanced pharmacy services should be available in all pharmacies unless there is varying need or low volume service required. We need to raise ambitions among our population for pharmacy services such that they benefit from the wider range of services being commissioned. A framework of auditable standards will be useful to ensure we maintain high quality pharmacy services in Wirral. A set of quality indicators is being discussed at a national level. The PCT already undertakes contract monitoring visits to all pharmacies and reviews staff skills, processes and premises. An action plan is developed and followed up if required. We need to do more to raise awareness of the current role of pharmacy in managing long term conditions and in supporting people to make healthy choices Issue 1: January

59 Looking ahead to the future when the national contract may include an extended range of services that reflect the focus on long term conditions and making healthy choices then we will need to ensure that alongside the changes to the service we change the perceptions of local people in relation to five principle messages (opposite) We need to work with our patients, pharmacists and our partners to change patient s perceptions of pharmacy. In relation to five key areas: - Community Pharmacy: part of the NHS - Experts on medicines - Working in partnership with your doctor - Helping people make healthy choices - Private and confidential service These findings and our proposed actions are supported by a national programme to raise awareness of pharmacy services and to build on the public s trust of pharmacy to secure their support for the future potential pharmacy services commissioning. It is worth noting that we have not received any complaints regarding opening hours, access to or provision of pharmaceutical services on Wirral. Issue 1: January

60 CONCLUSIONS AND RECOMMENDATIONS FOR THE FUTURE Key Findings This assessment has found that the population of Wirral has better access to pharmacy services than in our peer group and that there is capacity in the pharmacy network to absorb increases in activity from the expected growth in the population over the next five years. Our existing network provides a comprehensive essential pharmaceutical service to our population. When compared with PCTs within our peer group the provision in Wirral is better in terms of the number of pharmacies per head of population and workload indicators. The widespread availability of premises with consultation facilities in Wirral means that our population has good access to high quality premises. There is good access to pharmacy services throughout the week, into the evening and at weekends across Wirral. NHS Wirral relies on the extended hours provision by the 100 hour contracts. In addition, these extended hours contracts have negated the need for the PCT to resource evening and weekend rotas. Any change to these opening hours will have a detrimental effect on access and service provision. There is generally good provision of advanced and enhanced services across our population, we will continue to work with our existing contractors to ensure that this provision matches the needs of our population and that any inequalities in activity are minimised. Patients and public who have been consulted did not identify any specific gaps in provision which would require the commissioning of any new pharmacy contracts, patients felt that they had a good choice of pharmacy service providers. The PCT is not aware of any patients or members of the public that have submitted complaints regarding inadequate access to services. In summary, there is no identified need for pharmaceutical services which would be met by commissioning additional pharmacy contracts. The period of growth in commissioning enhanced services in line with local health needs now needs to be matched by a period of consolidation which is focused on ensuring that there is good access and consistent provision across the population for both enhanced and advanced services from existing contractors. Issue 1: January

61 Actions to consolidate existing services include: Access The equitable access initiative will have changed the pattern of GP opening hours, an audit comparing GP opening hours with pharmacy opening hours is needed to ensure that there continues to be joined up provision for patients. We will review lunchtime closure patterns to identify communities where coordination of lunch time closure between pharmacies would be beneficial so that closures do not overlap in order to improve access for patients. Premises and infrastructure We will work with our pharmacies to identify ways in which consultation facilities can be fully utilised for the benefit of our population and in particular for patients with a disability across Wirral and particularly in Birkenhead. Continuity of pharmacy staff We will work with our pharmacists and GPs to create better opportunities for joint working and networking in order to develop existing local relationships. We will focus on initiatives where there is common ground such as repeat dispensing and medicines use reviews. We will emphasise in our commissioning the importance of continuity and consistency of pharmacist provision to ensure that the experience of patients reflects our aspirations. Essential services We will work with our pharmacies to identify mechanisms to share best practice in undertaking interventions and dealing with pressures of work which present a barrier to activity We will encourage our pharmacy contractors to develop a strategy for redesigning dispensing activity through technology and skill mix to ensure that we maximise the potential of pharmacists and reduce barriers to new roles. Advanced services We will work to increase MUR activity by increasing the number of pharmacies that are accredited to provide MUR, and by encouraging consistent activity in accredited pharmacies. We will also work with our pharmacists to link the provision of MUR with the PCT s long term conditions strategy, particularly around patient education and improving adherence in long term conditions. Issue 1: January

62 Expand current work, linked to the PCT s referral for medication review service, to ensure MURs are well targeted to those most in need of support. We will increase the number of MUR referrals, triaged via the Medicines Management Medication Review Referral Service, for both pharmacy-based and domiciliary MURs Enhanced services We will audit activity at a locality level to identify gaps in provision across each enhanced service. We will ensure that our commissioning intentions in relation to enhanced services are reflected in the activity that we see from our community pharmacies by adopting minimum required activity in SLAs (for services where pharmacies invite patients to participate) We will identify pharmacies that are successfully delivering multiple enhanced services and work with them to share best practice with other providers. Directed Enhanced Services Applicants using one of the four exemptions to the control of entry test under the current legislation should be required to provide all of the following enhanced services: o Smoking cessation service o Weight management service for referred clients o Emergency hormonal contraception + service o Alcohol screening service o Sharps service (for insulin and other self-injected medication) In addition, applicants will be required to provide the following services if required by the PCT:- o Holding stocks of palliative care drugs if further providers are required, dependant on the spread of existing providers at the time o Services for drug misuse clients (supervised consumption and needle exchange) if clients choose to access services from those premises All applicants should therefore be prepared to offer these services and any future services that are commissioned in line with identified health needs. Issue 1: January

63 APPENDIX 1 PNA Development Core Team Director with lead responsibility :- Director of Primary Care and Provider Services PNA Core Team members:- Public Health Development Manager/Head of Health Protection Senior Health Intelligence Manager Head of Health and Wellbeing, Healthy Communities Finance Head of Involvement and Patient Experience Involvement Manager Head of Medicines Management Pharmaceutical Advisor* Improvement and Development Manager, Medicines Management Other involvement:- A paper setting out plans to develop the PNA was circulated to the Pharmacy Contracts Committee for feedback and this was discussed at the PCT s Corporate Director Group The process and consultation plans were discussed on a number of occasions at the PCT s Pharmacy Development Group. This group includes representation from the Local Pharmaceutical Committee Secretary and Vice-Chair. The Local Pharmaceutical Committee established a PNA working group and all LPC Committee members devoted time to supporting the PCT in the development of this PNA. Conflicts of interest *The PCT s Pharmaceutical Advisor has declared a potential conflict of interest given her interest in the family community pharmacy business. However this risk is managed since all final decisions on the choice of providers or analysis of service gaps is made by the Head of Medicines Management and there is no involvement in the decisions of the PCT s Pharmacy Contracts Committee. Issue 1: January

64 APPENDIX 2 Consultation Plan The consultation must allow a minimum period of 60 days from last consultee receiving the PNA, which can be assumed as 2 days from date circulated. Consultees Mechanism Responsibility Comment Required consultees Wirral Local Pharmaceutical Committee Wirral Local Medical Committee Contractors on the pharmaceutical list for NHS Wirral Electronic copy to LPC Secretary for circulation to the Committee Electronic copy to LMC Secretary for circulation to the Committee Paper copy to 86 pharmacies and head offices of multiples with receipt signature Medicines Management Medicines Management Medicines Management Local Authority Letter and hard copy Medicines Management NHS Trusts and Foundation Trusts in the area - Wirral Hospital - Cheshire and Wirral Partnership - Clatterbridge Centre for Oncology Letter and hard copy to Chief Executive Medicines Management Neighbouring PCTs -Western Cheshire Letter and hard copy to Chief Executive Medicines Management Onward circulation by WCPCT to their LMC and LPC Local Involvement Network and any other patient, consumer or community group in its area which in the opinion of the PCT has an interest in the provision of pharmaceutical services in its area. Issue 1: January

65 Wirral LINK PCT Membership Electronic copy to LINK for circulation/discussion/noting at their Board Circulation to those members willing to be utilised for consultation documents Engagement Engagement Older Persons Parliament Letter and hard copy to Chair Engagement Childrens and Young Peoples Parliament Letter and hard copy to Chair Engagement BME groups Letter and hard copy to Chair of WMO and CEO of Wirral Change Engagement Proposed additional targeted work with WMO/Wirral Change after PNA published Learning disability advocates Introductory letter to Advocates Engagement Proposed additional targeted work after PNA published with service users via LD health workers Voluntary and Community Groups Electronic copy to Voluntary and Community Action Wirral (VCAW) for circulation to groups on their database Engagement Voice of Wallasey, Patient Matters (BWW) Letter and hard copy to Chair Engagement No equivalent body in Birkenhead therefore circulate to Patient Participation Group Chairs Locally agreed consultees PBC groups/gp Forums for the three localities in Wirral Electronic copy to Chair Medicines Management Team Issue 1: January

66 APPENDIX 3 Location of pharmacies and allocation to localities and wards Bebington and West Wirral NHS Wirral FCS Code Pharmacy Name Add 1 Postcode Locality Ward FNE94 Swettenhams Chemists 176 Bebington Road CH63 7PD Bebington & West Wirral Bebington FY215 Your Local Boots Pharmacy 21 Church Road CH63 7PG Bebington & West Wirral Bebington FG049 Your Local Boots Pharmacy 118 Teehey Lane CH63 8QT Bebington & West Wirral Bebington FQ635 Cohens Chemist 4 Broadway CH63 5NH Bebington & West Wirral Bebington FC329 Swettenhams Chemists 18 Allport Lane CH62 7HP Bebington & West Wirral Bromborough FC972 Boots the Chemist Ltd Croft Retail Park CH62 3PN Bebington & West Wirral Bromborough FLM92 Boots the Chemist Ltd 3-5 The Precinct CH62 7AD Bebington & West Wirral Bromborough FKE81 Morsy Lewis Pharmacy 16 Cross Lane CH63 3AL Bebington & West Wirral Clatterbridge FFX32 W A Temple 3 Lancelyn Court Precinct CH63 9JP Bebington & West Wirral Clatterbridge FNR55 Dudleys Chemist 1194 New Chester Road CH62 9AE Bebington & West Wirral Eastham FMP28 Rowlands Pharmacy 154 Allport Road CH62 6BB Bebington & West Wirral Eastham FDF46 Tree Tops Pharmacy Bridle Road CH62 6AP Bebington & West Wirral Eastham FM378 Your Local Boots Pharmacy 148 Greasby Road CH49 3NQ Bebington & West Wirral Greasby, Frankby and Irby FCN12 Irby Pharmacy 39 Thingwall Road CH61 3UE Bebington & West Wirral Greasby, Frankby and Irby FJW37 Greasby Pharmacy Greasby Health Centre CH49 3AT Bebington & West Wirral Greasby, Frankby and Irby FV122 Boots the Chemist Ltd Telegraph Road CH60 0AL Bebington & West Wirral Heswall FA057 Heswall Hills Pharmacy 119 Brimstage Road CH60 1XF Bebington & West Wirral Heswall FPN00 Lloyds Pharmacy Telegraph Road CH60 0AL Bebington & West Wirral Heswall FKD97 Co-op Pharmacy Village Road CH60 0DZ Bebington & West Wirral Heswall FDL01 Tesco Pharmacy Telegraph Road CH60 7SL Bebington & West Wirral Heswall FJV77 Boots the Chemist Ltd The Crescent CH48 4HL Bebington & West Wirral Hoylake and Meols FJC28 Lloyds Pharmacy 35 Grange Road CH48 4DZ Bebington & West Wirral Hoylake and Meols FTM25 Manor Pharmacy 13 Station Approach CH47 8XA Bebington & West Wirral Hoylake and Meols FTG19 Morrisons Stores Pharmacy Dee Lane CH48 0QA Bebington & West Wirral Hoylake and Meols FNT31 Co-op Pharmacy 40 Market Street CH47 2AF Bebington & West Wirral Hoylake and Meols FE719 Welsh Chemist 90 Banks Road CH48 0RE Bebington & West Wirral Hoylake and Meols FMK56 Wilsons Chemist 17 The Crescent CH48 4HL Bebington & West Wirral Hoylake and Meols FQT68 Your Local Boots Pharmacy 509 Pensby Road CH61 7UQ Bebington & West Wirral Pensby and Thingwall FYF78 M & A Weinronk 413 Pensby Road CH61 9PF Bebington & West Wirral Pensby and Thingwall FPM20 Co-op Pharmacy 309 Pensby Road CH61 9NG Bebington & West Wirral Pensby and Thingwall Issue 1: January

67 Birkenhead FCS Code Pharmacy Name Add 1 Postcode Locality Ward FC593 Dale Pharmacy 224 Bebington Road CH42 4QF Birkenhead Bebington FMR00 Your Local Boots Pharmacy 30 Hoylake Road CH41 7BX Birkenhead Bidston and St James FKJ03 Birkenhead Pharmacy 31 Laird Street CH41 8DB Birkenhead Bidston and St James FDQ38 Morsy Lewis Pharmacy 41 Fender Way CH43 7ZJ Birkenhead Bidston and St James FFJ15 Tesco In-Store Pharmacy Bidston Link Road CH43 7AA Birkenhead Bidston and St James FQQ27 Vittoria Pharmacy 134 St Anne Street CH41 3SJ Birkenhead Bidston and St James FC368 Boots the Chemist Ltd 215 Grange Road CH41 2PH Birkenhead Birkenhead and Tranmere FLT67 Haven Chemist 36 Balls Road CH43 5RE Birkenhead Birkenhead and Tranmere FEP75 Jamiesons Pharmacy 44 Whetstone Lane CH41 2TF Birkenhead Birkenhead and Tranmere FR713 Rowlands Pharmacy 9 Princes Pavement CH41 2XY Birkenhead Birkenhead and Tranmere FX032 Rowlands Pharmacy 73 Market Street CH41 6AN Birkenhead Birkenhead and Tranmere FFP67 Superdrug Pharmacy Grange Road CH41 2PF Birkenhead Birkenhead and Tranmere FMP76 Swettenhams Chemist 41 Church Road CH42 5LD Birkenhead Birkenhead and Tranmere FA689 Rowlands Pharmacy 20 Bebington Road CH62 5BQ Birkenhead Bromborough FH921 Rowlands Pharmacy Parkfield Medical Centre CH62 5HS Birkenhead Bromborough FL617 Your Local Boots Pharmacy 395 Upton Road CH43 9SE Birkenhead Claughton FHV83 Claughton Pharmacy 161 Park Road North CH41 0DD Birkenhead Claughton FT523 Rowlands Pharmacy 2 Upton Road CH41 0DF Birkenhead Claughton FLX37 Townfield Pharmacy 2 Townfield Close CH43 9JW Birkenhead Claughton FG244 National Co-op Pharmacy Pasture Road Health Centre CH46 8SA Birkenhead Leasowe and Moreton East FLP52 Boots the Chemist Ltd 254 Hoylake Road CH46 6AF Birkenhead Moreton West and Saughall Massie FYM11 Lloyds Pharmacy Hoylake Road CH46 0SJ Birkenhead Moreton West and Saughall Massie FME16 Rowlands Pharmacy 2a Chadwick Street CH46 7TE Birkenhead Moreton West and Saughall Massie FRR82 Rowlands Pharmacy 53 Christchurch Road CH43 5SF Birkenhead Oxton FXX14 Your Local Boots Pharmacy 8-10 Holmlands Drive CH43 0TX Birkenhead Oxton FQX26 Your Local Boots Pharmacy 379 Woodchurch Road CH42 8PE Birkenhead Prenton FG595 Prenton Dell Pharmacy Dickens Avenue CH43 0TQ Birkenhead Prenton FCX09 Rowlands Pharmacy 62 Greenway Road CH42 7LX Birkenhead Prenton FK272 Your Local Boots Pharmacy 206 Bedford Road CH42 2AT Birkenhead Rock Ferry FE351 Lloyds Pharmacy Victoria Park Health Centre CH42 4QJ Birkenhead Rock Ferry FKF28 Old Chester Pharmacy 296 Old Chester Road CH42 3XD Birkenhead Rock Ferry Issue 1: January

68 FT638 Rowlands Pharmacy 525 New Chester Road CH42 2AG Birkenhead Rock Ferry FQ535 Swettenhams Chemist 249 Old Chester Road CH42 3TD Birkenhead Rock Ferry FMD34 Your Local Boots Pharmacy 23 Arrowe Park Road CH49 0UB Birkenhead Upton FN923 Your Local Boots Pharmacy 39 Fleetcroft Road CH49 5LZ Birkenhead Upton FV230 Lee s Pharmacy Ltd 98 Hoole Road CH49 8EG Birkenhead Upton FWP65 Lloyds Pharmacy Arrowe Park Hospital CH49 5PE Birkenhead Upton FY543 Rowlands Pharmacy 142 Ford Road CH49 0TQ Birkenhead Upton FW404 Sainsbury Pharmacy J Sainsbury Store CH49 6QG Birkenhead Upton Issue 1: January

69 Wallasey FCS Code Pharmacy Name Add 1 Postcode Locality Ward FR600 Leasowe Pharmacy Leasowe Primary Care Centre CH46 2QQ Wallasey Leasowe and Moreton East FJ202 Blackheath Pharmacy 113D Reeds Lane CH46 1QT Wallasey Leasowe and Moreton East FCT19 Your Local Boots Pharmacy 29 Liscard Way CH44 5TL Wallasey Liscard FYV68 Boots the Chemist Ltd 36 Liscard Way CH44 5TP Wallasey Liscard FTJ86 Egremont Pharmacy 9a King Street CH44 8AT Wallasey Liscard FWC76 Victoria Central Pharmacy VCH, Mill Lane CH44 5UP Wallasey Liscard FE310 Carrington Chemist 128 Rake Lane CH45 5DL Wallasey New Brighton FNC84 Rowlands Pharmacy Field Road CH45 5BG Wallasey New Brighton FCC27 Victoria Pharmacy 100 Victoria Road CH45 2JF Wallasey New Brighton FN054 Campbells Chemist 175 Poulton Road CH44 9DG Wallasey Seacombe FNN81 Somerville Pharmacy Somerville Medical Centre CH44 4SP Wallasey Seacombe FWD11 Wyn Ellis & Son Chemists 32 Poulton Road CH44 9DQ Wallasey Seacombe FXC10 G B Jackson 118 St Paul s Road CH44 7AW Wallasey Seacombe FF922 Asda Pharmacy Seaview Road CH45 4NZ Wallasey Wallasey FDA14 Rowlands Pharmacy 62 Grove Road CH45 3HW Wallasey Wallasey FQG90 Wallasey Village Pharmacy 95 Wallasey Village CH45 3LE Wallasey Wallasey FEL01 St Hilary s Pharmacy 202 Wallasey Road CH44 2AG Wallasey Wallasey Issue 1: January

70 APPENDIX 4 Opening hours of pharmacies Bebington and West Wirral Ward Code Name Post code Monday Tuesday Wednesday Thursday Friday Saturday Sunday Bebington FQ635 COHENS PHARMACY CH63 5NH 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 Closed Closed Closed Closed Bebington FNE94 SWETTENHAM CHEMISTS CH63 7PD 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 13:00 Closed Closed Bebington FY215 YOUR LOCAL BOOTS PCY CH63 7PG 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 17:00 Closed Closed Bebington FG049 YOUR LOCAL BOOTS PCY CH63 8QT 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 17:00 Closed Closed Bromborough FC972 BOOTS THE CHEMISTS CH62 3PN 08:30 20:00 08:30 20:00 08:30 20:00 08:30 20:00 08:30 20:00 08:30 18:30 10:00 16:00 Bromborough FLM92 BOOTS THE CHEMISTS CH62 7AD 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 Closed Closed Bromborough FC329 SWETTENHAM CHEMISTS CH62 7HP 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 13:00 Closed Closed Clatterbridge FKE81 MORSY LEWIS PHARMACY CH63 3AL 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 Closed Closed Closed Closed Clatterbridge FFX32 WA TEMPLE CH63 9JP 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 13:00 Closed Closed Eastham FDF46 DUDLEYS CHEMIST CH62 6AP 08:30 18:30 08:30 18:30 08:30 18:30 08:30 18:30 08:30 18:30 09:00 13:00 Closed Closed Eastham FMP28 ROWLANDS PHARMACY CH62 6BB 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 17:30 Closed Closed Eastham FNR55 DUDLEYS CHEMIST CH62 9AE 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 09:00 13:00 Closed Closed Greasby, Frankby FJW37 GREASBY PHARMACY CH49 3AT 09:00 18: : : : :00 09:00 13:00 Closed Closed Greasby, Frankby FM378 YOUR LOCAL BOOTS PCY CH49 3NQ 09:00 18:30 09:00 18:30 09:00 18:30 09:00 18:30 09:00 18:30 09:00 17:00 Closed Closed Greasby, Frankby FCN12 IRBY PHARMACY CH61 3UE 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 13:00 Closed Closed Heswall FV122 BOOTS THE CHEMISTS CH60 0AL 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 Closed Closed Heswall FPN00 LLOYDS PHARMACY CH60 0AL 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 17:30 Closed Closed Heswall FKD97 CO-OP PHARMACY CH60 0DZ 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 Closed Closed Closed Closed Heswall FA057 HESWALL HILLS PHARMACY CH60 1XF 09:00 18:00 09:00 18:00 09:00 13:00 09:00 18:00 09:00 18:00 09:00 13:00 Closed Closed Heswall FDL01 TESCO PHARMACY CH60 7SL 08:30 20:00 08:30 20:00 08:30 20:00 08:30 20:00 08:30 20:00 08:30 20:00 10:00 16:00 Hoylake and Meols FNT31 CO-OP PHARMACY CH47 2AF 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 17:30 Closed Closed Hoylake and Meols FTM25 MANOR PHARMACY CH47 8XA 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 13:00 Closed Closed Hoylake and Meols FTG19 MORRISONS PHARMACY CH48 0QA 09:00 20:00 09:00 20:00 09:00 20:00 09:00 21:00 09:00 21:00 09:00 20:00 10:00 16:00 Hoylake and Meols FE719 WELSH CHEMIST CH48 0RE 09:00 18:15 09:00 18:15 09:00 18:15 09:00 18:15 09:00 18:15 09:00 13:00 Closed Closed Hoylake and Meols FJC28 LLOYDS PHARMACY CH48 4DZ 08:30 18:00 08:30 18:00 08:30 18:00 08:30 18:00 08:30 18:00 09:00 17:00 Closed Closed Hoylake and Meols FJV77 BOOTS THE CHEMISTS CH48 4HL 08:30 17:30 08:30 17:30 08:30 17:30 08:30 17:30 08:30 17:30 09:00 17:30 Closed Closed Hoylake and Meols FMK56 WILSONS CHEMIST CH48 4HL 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:00 Closed Closed Pensby and Th wall FYF78 M & A WEINRONK* CH61 2PF 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 17:30 Closed Closed Pensby and Th wall FQT68 YOUR LOCAL BOOTS PCY CH61 7UQ 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 13:00 Closed Closed Pensby and Th wall FPM20 CO-OP PHARMACY CH61 9ND 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 Closed Closed Closed Closed Lunchtime closure: All pharmacies in italics close for one hour each day at approximately 13:00, pharmacies marked with a * do not close on Friday or Saturday. Issue 1: January

71 Birkenhead NHS Wirral Ward Code Pharmacy Postcode Monday Tuesday Wednesday Thursday Friday Saturday Sunday Bebington FC593 DALE PHARMACY CH42 4QF 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 13:00 Closed Closed Bidston and St James FQQ27 VITTORIA HEALTHCARE CH41 3SJ 09:00 18:30 09:00 18:30 09:00 18:30 09:00 18:30 09:00 18:30 Closed Closed Closed Closed Bidston and St James FMR00 YOUR LOCAL BOOTS PCY CH41 7BX 09:00 18:30 09:00 18:30 09:00 18:30 09:00 18:30 09:00 18:30 09:00 15:00 Closed Closed Bidston and St James FKJ03 BIRKENHEAD PHARMACY CH41 8DB 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 13:00 Closed Closed Bidston and St James FFJ15 TESCO PHARMACY CH43 7AA 08:00 22:30 06:30 22:30 06:30 22:30 06:30 22:30 06:30 22:30 06:30 22:00 10:00 16:00 Bidston and St James FDQ38 MORSY LEWIS CH43 7ZJ 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17: Closed Closed Birkenhead and Tran FFP67 SUPERDRUG PHARMACY CH41 2PF 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 Closed Closed Birkenhead and Tran FC368 BOOTS THE CHEMISTS CH41 2PH 08:30 17:30 08:30 17:30 08:30 17:30 08:30 17:30 08:30 17:30 08:30 17:30 10:30 16:30 Birkenhead and Tran FEP75 JAMIESON S PHARMACY CH41 2TF 08:45 18:00 08:45 18:00 08:45 18:00 08:45 18:00 08:45 18:00 Closed Closed Closed Closed Birkenhead and Tran FR713 ROWLANDS PHARMACY CH41 2XY 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 Closed Closed Birkenhead and Tran FX032 ROWLANDS PHARMACY CH41 5BS 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 09:00 13:00 Closed Closed Birkenhead and Tran FMP76 SWETTENHAM CHEMISTS CH42 5LD 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 13:00 Closed Closed Birkenhead and Tran FLT67 HAVEN CHEMIST CH43 5RE 09:00 18:30 09:00 18:30 09:00 18:30 09:00 18:30 09:00 18:30 09:00 12:00 Closed Closed Bromborough FA689 ROWLANDS PHARMACY* CH62 5BQ 09:00 18:00 09:00 18:00 09:00 13:00 09:00 18:00 09:00 18:00 09:00 17:30 Closed Closed Bromborough FVD93 ROWLANDS PHARMACY CH63 5HS 09:00 18:30 09:00 18:30 09:00 18:30 09:00 18:30 09:00 18:30 09:00 13:00 Closed Closed Claughton FHV83 CLAUGHTON PHARMACY CH41 0DD 07:00 22:30 07:00 22:30 07:00 22:30 07:00 22:30 07:00 22:30 07:00 22:30 09:00 16:00 Claughton FT523 ROWLANDS PHARMACY CH41 0DF 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 13:00 Closed Closed Claughton FLX37 TOWNFIELD PHARMACY CH43 9JW 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 13:00 Closed Closed Claughton FL617 YOUR LOCAL BOOTS PCY CH43 9SE 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 17:00 Closed Closed Leasowe and Morton FG244 NATIONAL CO-OP CH46 8SA 08:30 18:00 08:30 18:00 08:30 18:00 08:30 18:00 08:30 18:00 Closed Closed Closed Closed Moreton West FYM11 LLOYDSPHARMACY CH46 0SJ :00 08:30 18: : : :00 09:00 17:30 Closed Closed Moreton West FLP52 BOOTS THE CHEMISTS CH46 6AF 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 Closed Closed Moreton West FME16 ROWLANDS PHARMACY CH46 7TE 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 13:00 Closed Closed Oxton FXX14 YOUR LOCAL BOOTS PCY CH43 0TX 09:00 18:30 09:00 18:30 09:00 18:30 09:00 18:30 09:00 18:30 09:00 13:00 Closed Closed Oxton FRR82 ROWLANDS PHARMACY CH43 5SF 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 17:30 Closed Closed Prenton FCX09 ROWLANDS PHARMACY CH42 7LX 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 17:30 Closed Closed Prenton FQX26 YOUR LOCAL BOOTS PCY CH42 8PE 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 17:00 Closed Closed Prenton FG595 PRENTON DELL CH43 0TQ 09:00 18:30 09: :00 18:30 09: : :00 13:00 Closed Closed Rock Ferry FT638 ROWLANDS PHARMACY CH42 2AG 09:00 18:30 09:00 18:30 09:00 18:30 09:00 18:30 09:00 18:30 09:00 12:00 Closed Closed Rock Ferry FK272 YOUR LOCAL BOOTS PCY CH42 2AT 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 17:00 Closed Closed Rock Ferry FQ535 SWETTENHAM CHEMISTS CH42 3TD 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 Closed Closed Closed Closed Rock Ferry FKF28 OLD CHESTER PHARMACY CH42 3XD 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 12:30 Closed Closed Rock Ferry FE351 LLOYDS PHARMACY CH42 4QJ 08:30 18:00 08:30 18:00 08:30 18:00 08:30 18:00 08:30 18:00 Closed Closed Closed Closed Upton FY543 ROWLANDS PHARMACY CH49 0TQ 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:00 Closed Closed Issue 1: January

72 Upton FMD34 YOUR LOCAL BOOTS PCY CH49 0UB 09:00 18:00 09:00 18:00 09:00 17:30 09:00 18:00 09:00 18:00 09:00 17:30 Closed Closed Upton FN923 YOUR LOCAL BOOTS PCY CH49 5LZ 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 Closed Closed Closed Closed Upton FWP65 LLOYDS PHARMACY CH49 5PE 08:30 22:00 08:30 22:00 08:30 22:00 08:30 22:00 08:30 22:00 09:00 22:00 09:00 22:00 Upton FW404 SAINSBURYS PHARMACY CH49 6QG 07:00 23:00 07:00 23:00 07:00 23:00 07:00 23:00 07:00 23:00 07:00 22:00 10:00 16:00 Upton FV230 LEES S PHARMACY CH49 8EG 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 13:00 Closed Closed Lunchtime closure: All pharmacies in italics close for one hour each day at approximately 13:00, pharmacies marked with a * do not close on Saturday. Issue 1: January

73 Wallasey NHS Wirral Ward Code Name Postcode Monday Tuesday Wednesday Thursday Friday Saturday Sunday Leasowe and Moreton FJ202 BLACKHEATH PHARMACY CH46 1QT 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 13:00 Closed Closed Leasowe and Moreton FR600 LEASOWE PHARMACY CH46 2QQ 08:45 18:00 08:45 18:00 08:45 18:00 08:45 18:00 08:45 18:00 Closed Closed Closed Closed Liscard FCT19 YOUR LOCAL BOOTS PCY CH44 5TL 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 17:30 Closed Closed Liscard FWC76 VICTORIA CENTRAL PHARMACY CH44 5UP : : : : : Closed Closed Liscard FYV68 BOOTS THE CHEMISTS LTD CH44 5TP 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 Closed Closed Closed Closed Liscard FTJ86 EGREMONT PHARMACY CH44 8AT 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 Closed Closed Closed Closed New Brighton FCC27 VICTORIA PHARMACY CH45 2JF 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 17:30 Closed Closed New Brighton FNC84 ROWLANDS PHARMACY CH45 5BG : : : : :00 Closed Closed Closed Closed New Brighton FE310 CARRINGTON CHEMIST CH45 5DL 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 Closed Closed Closed Closed Seacombe FNN81 SOMERVILLE PHARMACY CH44 4SP 08:45 18:00 08:45 18:00 08:45 18:00 08:45 18:00 08:45 18:00 Closed Closed Closed Closed Seacombe FN054 CAMPBELLS CHEMIST CH44 9DG 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 13:00 Closed Closed Seacombe FWD11 WYN ELLIS & SON CH44 9DQ 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 13:00 Closed Closed Seacombe FXC10 JACKSON GB CH44 7AW 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 13:00 Closed Closed Wallasey FEL01 ST HILARY S PHARMACY CH44 2AG 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 13:00 Closed Closed Wallasey FDA14 ROWLANDS PHARMACY CH45 3HW 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 13:00 Closed Closed Wallasey FKE51 WALLASEY VILLAGE PHARMACY CH45 3LE 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 17:30 Closed Closed Wallasey FF922 ASDA PHARMACY CH45 4NZ 08:00 22:00 08:00 22:00 08:00 22:00 08:00 22:00 08:00 22:00 08:00 22:00 10:00 16:00 Lunchtime closure: All pharmacies in italics close for one hour each day at approximately 13:00. Issue 1: January

74 APPENDIX 5 Table of service providers Pharmacies Wallasey Issue 1: January Map ID Sharps Disposal Service Smoking Cessation Support *Weight Management NHS Wirral Alcohol Screening *Emergency Hormonal Contraception + Drug Misuse Services Your Local Boots Pharmacy 29 Liscard Way 1 Wallasey CH44 5TL 1 1 Asda Pharmacy Seaview Road 2 Wallasey CH45 4NZ Blackheath Pharmacy 113D Reeds Lane 3 Leasowe CH46 1QT Boots The Chemist 36 Liscard Way 4 Liscard CH44 5TP Campbells Chemist 175 Poulton Road 5 Wallasey CH44 9DG J Carrington Chemist 128 Rake Lane 6 Wallasey CH45 5DL Egremont Pharmacy 9a King Street 7 Wallasey CH44 8AT G B Jackson 118 St Paul s Road 8 Seacombe CH44 7AW Leasowe Pharmacy Leasowe PCC, Hudson Rd 9 Leasowe CH46 2QQ Victoria Central Pharmacy Victoria Central PCC, Mill Lane 10 Wallasey CH44 5UP Rowlands Pharmacy 62 Grove Road 11 Wallasey CH45 3HW 1 Rowlands Pharmacy Field Road M/C, Field Road 12 New Brighton CH45 5BG Wallasey Village Pharmacy 95 Wallasey Village 13 Wallasey CH45 3LE 1 Somerville Pharmacy Somerville Medical Centre 14 Wallasey CH44 4SP St Hilary s Pharmacy 202 Wallasey Road 15 Wallasey CH44 2AG Victoria Pharmacy 100 Victoria Road 16 New Brighton CH45 2JF Wyn Ellis & Son Chemists 32 Poulton Road 17 Wallasey CH44 9DQ Birkenhead Your Local Boots Pharmacy 206 Bedford Road 18 Rock Ferry CH42 2AT Your Local Boots Pharmacy 395 Upton Road 19 Noctorum CH43 9SE Your Local Boots Pharmacy 23 Arrowe Park Road 20 Upton CH49 0UB Your Local Boots Pharmacy 30 Hoylake Road 21 Birkenhead CH41 7BX Your Local Boots Pharmacy 39 Fleetcroft Road 22 Upton CH49 5LZ Needle Exchange Supervised Consumption Palliative Care Medicines Supply Advice to Care Homes

75 Issue 1: January NHS Wirral Your Local Boots Pharmacy 379 Woodchurch Road 23 Prenton CH42 8PE Your Local Boots Pharmacy 8-10 Holmlands Drive 24 Prenton CH43 OTX Boots The Chemist 215 Grange Road 25 Birkenhead CH41 2PH Your Local Boots Pharmacy 254 Hoylake Road 26 Moreton CH46 6AF Claughton Pharmacy 161 Park Road North 27 Claughton CH41 0DD Dale Pharmacy 224 Bebington Road 28 Rock Ferry CH42 4QF Haven Chemist 36 Balls Road 29 Oxton CH43 5RE Jamiesons Pharmacy 44 Whetstone Lane 30 Birkenhead CH41 2TF 1 1 Lee s Pharmacy 98 Hoole Road 31 Woodchurch CH49 8EG Lloyds Pharmacy Victoria Park HC, Bedford Ave 32 Rock Ferry CH42 4QL Lloyds Pharmacy Arrowe Park Hospital 33 Upton CH49 5PE Lloyds Pharmacy Hoylake Road 34 Moreton CH46 0SJ Birkenhead Pharmacy 31 Laird Street 35 Birkenhead CH41 8DB Morsy Lewis Pharmacy 41 Fender Way 36 Beechwood CH43 7ZJ Co-Op Chemist Pasture Road Health Centre 37 Moreton CH46 8SA 1 1 Old Chester Pharmacy 296 Old Chester Road 38 Rock Ferry CH42 3XD Prenton Dell Pharmacy Dickens Avenue 39 Prenton CH43 0TQ Rowlands Pharmacy 2 Upton Road 40 Claughton CH41 0DF Rowlands Pharmacy 142 Ford Road 41 Upton CH49 0TQ 1 1 Rowlands Pharmacy 20 Bebington Road 42 New Ferry CH62 5BQ Rowlands Pharmacy 62 Greenway Road 43 Birkenhead CH42 7LX Rowlands Pharmacy Parkfield Medical Centre 44 New Ferry CH62 5HS Rowlands Pharmacy 2a Chadwick Street 45 Moreton CH46 7TE Rowlands Pharmacy 9 Princes Pavement 46 Birkenhead CH41 2XY Rowlands Pharmacy 53 Christchurch Road 47 Oxton CH43 5SF Rowlands Pharmacy 525 New Chester Road 48 Rock Ferry CH42 2AG Rowlands Pharmacy 73 Market Street 49 Birkenhead CH41 6AN Sainsbury Pharmacy Upton-by-Pass 50 Upton CH49 6QG Superdrug Pharmacy Grange Road 51 Birkenhead CH41 2PF Swettenhams Chemist 249 Old Chester Road 52 Tranmere CH42 3TD Swettenhams Chemist 41 Church Road 53 Tranmere CH42 5LD Tesco In-Store Pharmacy Bidston Link Road 54 Birkenhead CH43 7AA Townfield Pharmacy 3 Townfield Close 55 Noctorum CH43 9JW Vittoria Pharmacy 134 St Anne Street 56 Birkenhead CH41 3SJ Bebington and West Wirral M & A Weinronk 413 Pensby Road 57 Pensby CH61 9PF

76 Issue 1: January NHS Wirral Swettenhams Chemist 176 Bebington Road 58 Lower Bebington CH63 7PD Your Local Boots Pharmacy 509 Pensby Road 59 Pensby CH61 7UQ Boots The Chemist Croft Retail Park 60 Bromborough CH62 3PN Your Local Boots Pharmacy The Crescent 61 West Kirby CH48 4HL Your Local Boots Pharmacy 3-5 The Precinct 62 Bromborough CH62 7AD Boots The Chemist Telegraph Road 63 Heswall CH60 0AL Cohens Pharmacy 4 Broadway 64 Higher Bebington CH63 5NH Tree Tops Pharmacy 49 Bridle Road 65 Bromborough CH62 6EE Dudleys Chemist 1194 New Chester Road 66 Eastham CH62 9AE Greasby Pharmacy Greasby HC, 424 Frankby Rd 67 Greasby CH49 3AT Heswall Hill Pharmacy 119 Brimstage Road 68 Heswall CH60 1XF Irby Pharmacy 39 Thingwall Road 69 Irby CH61 3UE Lloyds Pharmacy Telegraph Road 70 Heswall CH60 0AL Lloyds Pharmacy 35 Grange Road 71 West Kirby CH48 4DZ Manor Pharmacy 13 Station Approach 72 Meols CH47 8XA Morrison Stores Pharmacy Dee Lane 73 West Kirby CH48 0QA Morsy Lewis Pharmacy 16 Cross Lane 74 Higher Bebington CH63 3AL Co-Op Chemists Ltd Village Road 75 Heswall CH60 0DZ 1 1 Co-Op Chemists Ltd 40 Market Street 76 Hoylake CH47 2AF Co-Op Chemists Ltd 309 Pensby Road 77 Pensby CH61 9ND Rowlands Pharmacy 154 Allport Road 78 Bromborough CH62 6BB 1 Swettenhams Chemist 18 Allport Lane 79 Bromborough CH62 7HP W A Temple 3 Lancelyn Court Precinct 80 Spital CH63 9JP 1 1 Tesco Pharmacy Telegraph Road 81 Heswall CH60 7SL Welsh Chemist 90 Banks Road 82 West Kirby CH48 0RE 1 1 Wilsons Pharmacy 17 The Crescent 83 West Kirby CH48 4HL Your Local Boots Pharmacy 118 Teehey Lane 84 Higher Bebington CH63 8QT Your Local Boots Pharmacy 148 Greasby Road 85 Greasby CH49 3NQ Your Local Boots Pharmacy 21 Church Road 86 Lower Bebington CH63 7PG Total Other Providers Wallasey All Day Health Centre Arrowe Park Hospital 1 Upton CH49 5PE 1 1 Community Mental Health Team Victoria Central Health Centre, Highfield Centre, Mill Lane 2 Wallasey CH44 5UF 1 Leasowe Millennium Centre Twickenham Drive 3 Leasowe CH46 1PQ 1

77 Leasowe Primary Care Centre - WSH Hudson Road 4 Leasowe CH46 2QQ 1 1 New Brighton Comm Centre Hope Street 5 New Brighton CH45 2LN 1 St Georges Medical Centre - CAS (Confidential Advice Service) Field Road 6 Wallasey CH45 5LN 1 The Social Partnership 67 St Pauls Road 7 Seacombe CH44 7AJ 1 Victoria Central Hospital Mill Lane 8 Wallasey CH44 5US Birkenhead 30 Argyle Street Birkenhead 9 CH41 6AE 1 1 Adult Mental Health, Stein Centre St Catherine's Hospital 10 Tranmere CH42 0LQ 1 ARCH Initiatives 23 Conway Street 11 Birkenhead CH41 6PT 1 Arrowe Park Hospital - GUM (Genito Urinary Medicine) Arrowe Park Road 12 Upton CH49 5PE 1 Birkenhead One Stop Shop Conway Street 13 Birkenhead CH41 6JD 1 Birkenhead Sixth Form College Clinic Park Road West 14 Claughton CH43 8SQ 1 Birkenhead YMCA 56 Whetstone Lane 15 Birkenhead CH41 2TJ 1 Brassey Gardens Childrens Centre 2 Brassey Gardens 16 Birkenhead CH41 8DA 1 Claughton Medical Centre - GUM (Genito Urinary Medicine) 161 Park Road North 17 Claughton CH41 0DD 1 Early Years Centre. New Hey Road 18 Woodchurch CH49 8HB 1 Ganney s Meadow New Hey Road 19 Woodchurch CH49 8HB 1 Harm Reduction Unit St Catherines Hospital 20 Tranmere CH42 0LQ 1 Miriam Health Centre - WSH (Wirral Sexual Health) Clinic 31 Laird Street 21 Birkenhead CH41 8DB 1 Moreton Library Pasture Road 22 Moreton CH46 8SA 1 Outreach via Harm Reduction Unit St Catherine's Hospital 23 Tranmere CH42 0LQ 1 Parkfield (New Ferry) Clinic - WSH Sefton Road 24 New Ferry CH62 5AP 1 Salvation Army Vincent Street 25 Birkenhead CH41 2RH 1 St Catherines Hospital Church Road 26 Birkenhead CH42 0LQ 1 1 St James Centre Laird Street 27 Birkenhead CH41 7AL 1 The Lodge and WSH (Wirral Sexual Health) Clinic Arrowe Park Hospital 28 Upton CH49 5PE 1 The Social Partnership 288 Hoylake Road 29 Moreton CH46 6AF 1 NHS Wirral Issue 1: January

78 The Social Partnership 1 Hassal Road 30 Rock Ferry CH42 1QR 1 Wirral Brook Advisory Service 14 Whetstone Lane 31 Birkenhead CH41 2QR 1 Wirral Heart Support St Catherine's Hospital 32 Tranmere CH42 0LQ 1 Wirral Independent Living Hind Street 33 Birkenhead CH41 5DA 1 Bebington & West Wirral Alexander Hall Rocky Lane 34 Heswall CH60 0AF 1 Bebington One Stop Shop, Pennant House, The Village 35 Bebington CH63 7PL 1 Civic Medical Centre Civic Way 36 Bebington CH63 7RX 1 Eastham Clinic 31 Eastham Rake 37 Eastham CH62 9AN Greasby Clinic Greasby Road, Greasby, Wirral, Merseyside Greasby Road 38 Greasby CH49 3AT 1 1 Heswall Clinic Telegraph Road 39 Heswall CH60 7SG 1 Heswall Clinic - WSH (Wirral Sexual Health) Telegraph Road 40 Heswall CH60 7SG 1 The Concourse Grange Road 41 West Kirby CH48 4HZ 1 West Kirby Clinic - WSH (Wirral Sexual Health) The Concourse 42 West Kirby CH48 4HZ 1 West Kirby Library The Concourse 43 West Kirby CH48 4HX 1 West Kirby Methodist Church Westbourne Road 44 West Kirby CH48 4DQ 1 NHS Wirral Westbourne Hall Community Centre 59 Westbourne Road 45 West Kirby CH48 4DQ 1 Total GP Practices Wallasey All Day Health Centre Arrowe Park Hospital 1 Upton CH49 5PE Blackheath Medical Centre 76 Reeds Lane 2 Leasowe CH46 1SG Central Park Medical Centre Victoria Central Health Centre 3 Wallasey CH44 5UF Earlston Road Surgery 1 Earlston Road 4 Wallasey CH45 5DX Egremont Medical Centre 9 King Street 5 Wallasey CH44 8AT 1 1 Field Road Health Centre Field Road 6 Wallasey CH45 5BG Grove Medical Centre 27 Grove Road 7 Wallasey CH45 3HE 1 Grove Road Surgery 71 Grove Road 8 Wallasey CH45 3HF Leasowe PCT 64 Twickenham Drive 9 Leasowe CH46 1PF 1 1 Leasowe Primary Care Centre Hudson Road 10 Leasowe CH46 2QQ 1 Liscard Group Practice Victoria Central Health Centre 11 Wallasey CH44 5UF Manor Health Centre Liscard Village 12 Wallasey CH45 4JG Issue 1: January

79 Mill Lane Surgery Victoria Central Health Centre 13 Wallasey CH44 5UF 1 1 St Georges Medical Centre Field Road 14 Wallasey CH45 5LN 1 1 St Hilary Brow Group Practice 204 Wallasey Road 15 Wallasey CH44 2AG 1 1 Seabank Medical Centre 213/215 Seabank Road 16 Wallasey CH45 1HE 1 1 Somerville Medical Centre 69 Gorsey Lane 17 Wallasey CH44 4AA 1 1 Issue 1: January NHS Wirral Wallasey Village Medical Centre 50 Wallasey Village 18 Wallasey CH45 3NL Total Birkenhead Cavendish Medical Centre 31 Laird Street 19 Birkenhead CH41 8DB 1 1 Claughton Medical Centre 161 Park Road North 20 Claughton CH41 0DD 1 Commonfield Road Surgery 156 Commonfield Road 21 Woodchurch CH49 7LP 1 Devaney Medical Centre 40 Balls Road 22 Oxton CH43 5RE 1 Fender Way Health Centre Fender Way 23 Noctorum CH43 9QS 1 1 Gladstone Medical Centre 241/247 Old Chester Road 24 Birkenhead CH42 3TD 1 1 Greenway Road Surgery 62 Greenway Road 25 Tranmere CH42 7LX 1 Hamilton Medical Centre 86 Market Street 26 Birkenhead CH41 6AJ 1 1 Heatherlands Medical Centre New Hey Road 27 Woodchurch CH49 9DA 1 1 Holmlands Medical Centre 16/20 Holmlands Drive 28 Oxton CH43 0TX 1 1 Hoylake Road Medical Centre 314 Hoylake Road 29 Moreton CH46 6DE 1 1 Miriam Medical Centre 31 Laird Street 30 Birkenhead CH41 8DB 1 1 Moreton Cross Group Practice Pasture Road 31 Moreton CH46 8SA Moreton Health Clinic 8/14 Chadwick Street 32 Moreton CH46 7XA 1 1 Moreton Medical Centre 27 Upton Road 33 Moreton CH46 0PE 1 1 Parkfield Medical Centre (Dr C) Sefton Road 34 New Ferry CH62 5HS 1 1 Parkfield Medical Centre (Dr H) Sefton Road 35 New Ferry CH62 5HS 1 Prenton Medical Centre 516/518 Woodchurch Road 36 Prenton CH43 0TS 1 1 Riverside Surgery 525 New Chester Road 37 Birkenhead CH42 2AG 1 Upton Group Practice 32 Ford Road 38 Upton CH49 0TF 1 Victoria Park Health Centre Bedford Avenue 39 Birkenhead CH42 4QJ 1 1 Villa Medical Centre Roman Road 40 Prenton CH43 3DB 1 1 Vittoria Medical Centre (Dr E) Vittoria Street 41 Birkenhead CH41 3RH 1 Vittoria Medical Centre (Dr M) Vittoria Street 42 Birkenhead CH41 3RH 1 1 Whetstone Medical Centre 44 Whetstone Lane 43 Birkenhead CH41 2TF 1 Woodchurch Medical Centre 33/35 Poolwood Road 44 Woodchurch CH49 9BP 1 1 Woodchurch Road Surgery 270 Woodchurch Road 45 Prenton CH43 5UU 1 1 Total

80 Bebington & West Wirral Civic Medical Centre Civic Way 48 Bebington CH63 7RX 1 Church Road Medical Centre 64 Church Road 47 Bebington CH63 3EY 1 Eastham Group Practice 43 Bridle Way 49 Bromborough CH62 6EE 1 1 Allport Surgery 43 Bridle Way 46 Bromborough CH62 6EE 1 1 Teehey Lane Medical Centre 66/68 Teehey Lane 59 Bebington CH63 2JN 1 1 The Orchard Surgery Bromborough village Road 60 Bromborough CH62 7EU 1 Kings Lane Medical Centre 100 Kings Lane 54 Bebington CH63 5LY 1 Spital surgery 1 Lancelyn Court Precinct 58 Bebington CH63 9JP 1 Sandstone Medical Centre 161 Banks Road 56 West Kirby CH48 3HU 1 Hoylake & Meols Medical Centre Station Approach 52 Meols CH47 8XA 1 West Kirby Health Centre (Dr W) The Concourse, Grange Road 64 West Kirby CH48 4HZ 1 West Kirby Health Centre (Dr Si) The Concourse, Grange Road 63 West Kirby CH48 4HZ 1 West Kirby Health Centre (Dr Sm) The Concourse, Grange Road 62 West Kirby CH48 4HZ 1 Greasby Group Practice Greasby Road 50 Greasby CH49 3AT 1 Silverdale Medical Centre Mount Avenue 57 Heswall CH60 4RH 1 Pensby Surgery 349 Pensby Road 55 Pensby CH61 9NL 1 1 Heswall Medical Centre 270 Telegraph Road 51 Heswall CH60 7SG 1 1 Winterdyne 8 Rocky Lane 65 Heswall CH60 0BY 1 Irby Surgery 33 Thingwall Road 53 Irby CH61 3UF 1 NHS Wirral Thingwall Surgery 530 Pensby Road 61 Thingwall CH61 7UF Total Issue 1: January

81 APPENDIX 6 - Maps of services NHS Wirral Wirral Community Pharmacies Issue 1: January

82 Those shown in yellow do not provide the service Issue 1: January

83 Issue 1: January NHS Wirral

84 Wirral Community Pharmacies Weight Management Issue 1: January

85 Issue 1: January NHS Wirral

86 Wirral Community Pharmacies Emergency Hormonal Contraception Issue 1: January

87 Issue 1: January Wirral Community Pharmacies Emergency Hormonal Contraception Wirral Community Pharmacies Needle Exchange

88 Issue 1: January NHS Wirral

89 Wirral Community Pharmacies Palliative Care Medicines Supply Issue 1: January

90 Wirral Community Pharmacies Advice to Care Homes Issue 1: January

91 5 6 Other Service Providers 44, , 42, , 19 1, 12, , , , 20, 23, 26, , Issue 1: January

92 44, , 42, , 19 1, 12, , , , 20, 23, 26, NHS Wirral Other Service Providers Smoking Cessation Support Those shown in yellow do not provide the service 40, Issue 1: January

93 5 6 Other Service Providers Weight Management 44, , 42, , 19 1, 12, , , , 20, 23, 26, , Issue 1: January

94 5 6 Other Service Providers Alcohol Screening 44, , 42, , 19 1, 12, , , , 20, 23, 26, , Issue 1: January

95 6 5 Other Service Providers Emergency Hormonal Contraception 41, 42, 43 44, , 19 1, 12, , , , 20, 23, 26, , Issue 1: January

96 5 6 Other Service Providers Needle Exchange 44, , 42, , 19 1, 12, , , , 20, 23, 26, , Issue 1: January

97 NHS Wirral Wirral GP Practices Issue 1: January

98 Wirral GP Practices Weight Management Those shown in yellow do not provide the service Issue 1: January

99 Wirral GP Practices Alcohol Screening Issue 1: January

100 , Wirral GP Practices Smoking Cessation Support Issue 1: January

101 APPENDIX 7 Community Pharmacy Patient Questionnaire Report The Department of Health and Pharmaceutical Services Negotiating Committee PSNC have agreed the requirements to fulfil paragraph 26 (2) (a) (iii) of Schedule 1 to the National Health Service (Pharmaceutical Services) Regulations the requirement to conduct an annual community pharmacy patient questionnaire (formerly referred to as the Patient Satisfaction Questionnaire). The questionnaire allows patients to provide valuable feedback to community pharmacies on the services they provide. The minimum number of returned surveys is defined in the regulations and is based upon the dispensing volume of the pharmacy. If all 86 Wirral pharmacies were to obtain survey responses from the minimum number of patients required, Wirral pharmacies would have collected data from 9025 pharmacy users. There is no requirement for pharmacies to share the findings of this survey with the PCT however after a request from NHS Wirral to all Wirral pharmacies 72 pharmacies (84%) were willing to share a summary of their findings with us. This would amount to a survey sample of approximately 7675 service users. Due to the voluntary nature of the information shared with the PCT, the data returned is variable in content and in the detail provided by each contractor. The majority of contractors have chosen to provide their feedback using the PSNC template. This template allows feedback to be given in a format specifying three areas in which the pharmacy is performing strongly and one area where the survey has identified the greatest potential for improvement. Four contractors have sent us the full survey details including raw data. Forty two contractors provided us with summaries within which they included quantified data i.e. included the percentages of responses which were favourable. The remaining twenty six returns gave information without numerical data. From this return we are able to draw some broad conclusions, percentages are included wherever this information has been shared with the PCT. Areas in which the pharmacy is performing strongly Area descriptor Number of surveys in which this area was identified in the top 3 Minimum % from contractors returns Maximum % from contractors returns The service you received from the other 36 73% 100% pharmacy staff The cleanliness of the pharmacy 28 85% 100% Issue 1: January

102 Satisfaction with the time it took to provide 27 72% 99% your prescription and/or any other NHS services you required Providing an efficient service 25 70% 100% Being polite and taking the time to listen 24 75% 100% to what you want The service you received from the 22 89% 92% pharmacist Having in stock the medicines/appliances 13 73% 97% you need Finally, taking everything into account - the 11 67% 99% staff, the shop and the service provided overall rating Offering a clear and well organised layout Answering any queries you may have 5 81% 89% Providing advice on a current health problem or a longer term health condition Providing general advice on leading a more healthy lifestyle The comfort and convenience of the waiting areas (e.g. seating or standing room) Offering a clear and well organised layout From these results it appears that the pharmacy staff may be the biggest attribute valued by customers. Four of the top five scoring areas are directly influenced by the performance, skills and attitude of the staff. Some relevant quotes taken from respondents in the survey: I use this pharmacy all the time as the staff are very kind and helpful and make you feel very welcome A well rounded service and very friendly staff This pharmacy is an excellent support to the treatment I receive from my doctor. This encourages confidence and encourages me to feel healthier Always order, collect and deliver if I can t get out. Nice people Fantastic service, modern methods but traditional service. Always willing to listen anytime, very caring. I feel my health is their prime concern. Superb I really don t think there could be any improvements. Always an excellent service provided by staff. They are always cheerful, helpful and polite. Well done!!! Issue 1: January

103 Areas identified with the greatest potential for improvement Area descriptor Number of surveys in which this area was identified as greatest potential for improvement NHS Wirral Minimum % from contractors returns Maximum % from contractors returns Providing general advice on leading a 29 21% 90% more healthy lifestyle Having somewhere available to speak 8-89% without being overheard Providing advice on health services or 7 25% 50% information available elsewhere The comfort and convenience of the waiting areas (e.g. seating or standing room) Offering a clear and well organised layout Satisfaction with the time it took to provide the prescription and/or other NHS service 3-49% How long you have to wait to be served Disposing of medicines you no longer need Providing advice on a current health problem or a longer term health condition The areas identified for improvement may not necessarily be the lowest scoring area but the areas within which the contractor feels that improvement can deliver the biggest impact to customer care. Four of these areas identified are linked to the range of services or advice offered, two to the quality of service and three to the physical environment. The lower percentage of positive responses to areas reflecting the range of services provided may be influenced by the size of the population who require access to such services e.g. one contractor identified specifically that only 18 % of respondents had accessed smoking cessation services. However, in his case this may reflect 100% of service users who require access to this service. Some relevant quotes taken from respondents in the survey: Some customers are unaware of the services patient education is the key I have a daily prescription, rather than waiting for it to be ready it could be ready and waiting for me to collect within 5-10 minutes of arriving in pharmacy You may have to wait for your prescription to be ready. They need another pharmacist Issue 1: January

104 Some actions Identified by pharmacists to improve the service provided include: 64% of respondents state they have never used this pharmacy as a source of advice. This is an area of service we will advertise in future. We have an excellent consulting room but people do not realise this so we are trying to tell more patients and even take them in to it even for more minor matters to improve awareness that there is somewhere confidential to speak to the pharmacist To promote services we provide we will use better signage to direct patients. Staff will promote MURs and other services To improve seating for elderly people we will obtain chairs with arms a different colour to the others to highlight them 90% of customers had not been advised on stopping smoking, physical exercise or healthy eating. To address this we will use ask your pharmacist leaflets and a range of information leaflets to prompt and encourage discussion. Personnel could be more pro-active in promoting our enhanced pharmacy services. Consider displaying our pharmacy practice leaflet in a more prominent position and support staff in any necessary training Encourage discussion with customers on lifestyle issues by encouraging staff to ask if customers have any other healthcare needs Issue 1: January

105 APPENDIX 8 Guidance and further reading NHS Wirral Pharmacy in England: building on strengths - delivering the future This White Paper sets out a vision for building on the strengths of pharmacy, using that capacity and capability to deliver further improvements in pharmaceutical services over the coming years as part of an overall strategy to ensure safe, effective, fairer and more personalised patient care. nce/dh_ PNAs as a part of world class commissioning guidance. This guidance sets out why s (PNAs) are important, how they fit into the primary care trust (PCTs) planning cycle and how it can be used to drive intelligent, world class commissioning of pharmaceutical services. asapartofworldclasscommissioning.aspx Developing pharmaceutical needs assessments guidance This guidance and individual supporting guides explain why Pharmaceutical Needs Assessments (PNAs) are important and how they fit into PCTs' planning cycles. It outlines how to produce a new PNA or revise an existing one. Guidance.aspx Pharmacy-based stop smoking services guidance This guidance covers the key areas for primary care trusts (PCTs) when commissioning 'world class' pharmacy-based stop smoking services. macy-basedsmokingservices.aspx The NHS (Pharmaceutical Services) Regulations: information for primary care trusts - revised September 2009 This guidance has been produced to assist primary care trusts in the assessment and determination of applications to provide NHS pharmaceutical services. It incorporates reforms effective from 1 April 2005 to the regulatory system and amendments to the Regulations since. This includes the amendments which came into force on 17 September SI 2009/2205. It also incorporates supplementary information for primary care trusts on the NHS Pharmaceutical Services (Fees for Applications) Directions 2008 which give primary care trusts the ability to charge for certain applications for inclusion on their NHS pharmaceutical services lists. nce/dh_ Issue 1: January

106 World class commissioning: Improving Pharmaceutical Services This is a practical guide to support PCTs in commissioning pharmaceutical services. Local pharmaceutical services (LPS) LPS is a tool available to PCTs by which they may contract locally for provision of pharmaceutical and other services, including services not traditionally associated with pharmacy, within a single contract. Localpharmaceuticalservices/LPSPermanenceguidance/index.htm Advisory Group on the NHS (Pharmaceutical Services) Regulations Following the publication of the White Paper Pharmacy in England: Building on strengths - delivering the future, a consultation was held in the autumn 2008 on proposals for legislative change. Following this consultation, the Health Bill 2009 was published and laid before Parliament, and contains proposals to: require primary care trusts to develop and publish pharmaceutical needs assessments (PNAs); and then to use PNAs as the basis for determining market entry to NHS pharmaceutical services provision to introduce new quality requirements for contractors. Subject to Parliamentary approval, regulations are needed to translate these proposals into reality. The Advisory Group on the NHS (Pharmaceutical Services) Regulations has been set up to develop these regulations and the associated guidance. The Advisory Group regularly publishes proceedings from its meetings which allow PCTs to follow the development of the regulations they will be responsible for implementing in 2010 and RegulationsAdvisoryGroup/index.htm Issue 1: January

107 APPENDIX 9 NHS Wirral Strategic Plan Our vision our health needs NHS Wirral The diagram below summarises on one page our vision and key health needs, gives examples of targeted investments and details the high level outcomes which we aspire to. It also shows the key strategies which have been developed to assist in implementation of the strategy. There then follows a one page summary of each of the key health needs, showing our selected outcome and goals and a brief summary of our initiatives. We have also included a brief summary of what success will look like for the residents of the Wirral. Issue 1: January

108 Health inequalities and Life Expectancy Issue 1: January

109 Alcohol Issue 1: January

110 Cancer Issue 1: January

111 COPD Issue 1: January

112 CVD and Stroke Issue 1: January

113 Mental Health Issue 1: January

114 Obesity Issue 1: January

115 Sexual Health Issue 1: January

116 Smoking Issue 1: January